Desai Aarti, Sharma Shriya, Siaw Adj, Ruiz Jose, Gómez Victoria, Goswami Rohan
Division of Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL, United States.
Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States.
Front Cardiovasc Med. 2025 May 7;12:1579218. doi: 10.3389/fcvm.2025.1579218. eCollection 2025.
Obesity significantly increases the risk of advanced heart failure, complicating heart transplantation candidacy. Despite aggressive medical therapies, achieving weight loss in these patients remains challenging, especially in patients after durable ventricular assist device (LVAD). More intense weight loss interventions such as bariatric and metabolic surgery and endoscopic bariatric therapies (EBTs) can lead to meaningful weight reduction, enabling previously ineligible individuals to become transplant candidates. A 51-year-old gentleman with end-stage heart and kidney failure status-post HeartMate 3 LVAD (Abbott, Chicago, IL) and Class II obesity (BMI 36.5 kg/m), was deemed ineligible for heart transplant due to high BMI (≥35 kg/m). Despite lifestyle modification, he was unable to lose weight, and BMI increased to 40.8 kg/m over the next 10 months. A multi-disciplinary discussion was held to discuss possible weight loss options, and after careful consideration, bariatric surgery was not deemed safe. The decision was made to proceed with EBTs, and an intragastric balloon (IGB) was successfully placed as a bridge to heart transplant. The IGB was removed at the six-month period per standard of care, and the patient had lost 16.5 Kg, achieving a 12.4% Total Body Weight Loss with a BMI of 35.3 kg/m. The patient underwent successful heart and kidney transplant and is now two months post-transplant. His BMI 2-months post-transplant is 37 kg/m. This case highlights the feasibility and efficacy of EBT therapy with IGB placement as an alternative to bariatric surgery for patients with LVAD placement and significant comorbidities who need to lose clinically significant weight to be deemed eligible for heart transplant.
肥胖显著增加晚期心力衰竭的风险，使心脏移植候选资格变得复杂。尽管有积极的药物治疗，但在这些患者中实现体重减轻仍然具有挑战性，尤其是在接受持久心室辅助装置（LVAD）治疗后的患者中。更强化的体重减轻干预措施，如减肥和代谢手术以及内镜减肥疗法（EBTs），可以导致有意义的体重减轻，使以前不符合条件的个体成为移植候选者。一名51岁的男性，患有终末期心脏和肾衰竭，已植入HeartMate 3 LVAD（雅培公司，伊利诺伊州芝加哥），属于II级肥胖（BMI 36.5 kg/m²），由于BMI高（≥35 kg/m²），被认为不适合进行心脏移植。尽管改变了生活方式，但他仍无法减重，在接下来的10个月里BMI增加到了40.8 kg/m²。进行了多学科讨论以探讨可能的减肥选择，经过仔细考虑，减肥手术被认为不安全。决定采用EBTs，成功放置了胃内气球（IGB）作为心脏移植的桥梁。按照护理标准，在6个月时取出了IGB，患者体重减轻了16.5 kg，总体重减轻了12.4%，BMI为35.3 kg/m²。患者成功接受了心脏和肾脏移植，目前移植后两个月。他移植后2个月的BMI为37 kg/m²。该病例突出了IGB放置的EBT治疗作为减肥手术的替代方法的可行性和有效性，适用于植入LVAD且有严重合并症、需要减轻显著体重以符合心脏移植条件的患者。
