For adults with advanced heart failure, class II/III obesity (body mass index ≥35 kg/m2) represents major challenges, and it is even considered a contraindication for heart transplantation (HT) at many centers. This has led to growing interest in preventing and treating obesity to help patients with advanced heart failure become HT candidates. Among all weight-loss strategies, bariatric surgery (BSx) has the greatest weight loss efficacy and has shown value in enabling select patients with left ventricular assist devices (LVADs) and obesity to lose sufficient weight to access HT. Nevertheless, both BSx and antiobesity medications warrant caution in the LVAD population. In this review, the authors describe and interpret the available published reports on the impact of obesity and weight-loss strategies for patients with LVADs from general and HT candidacy standpoints. The authors also provide an overview of the journey of LVAD recipients who undergo BSx and review major aspects of perioperative protocols.

中文翻译：

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心室辅助装置患者的肥胖、挑战和减肥策略


对于患有晚期心力衰竭的成年人来说，II/III级肥胖（体重指数≥35 kg/m2）是一项重大挑战，甚至在许多中心被认为是心脏移植（HT）的禁忌症。这导致人们对预防和治疗肥胖以帮助晚期心力衰竭患者成为 HT 候选者越来越感兴趣。在所有减肥策略中，减肥手术 (BSx) 具有最大的减肥效果，并且在使选择使用左心室辅助装置 (LVAD) 和肥胖的患者减轻足够的体重以进行 HT 方面已显示出价值。尽管如此，在 LVAD 人群中使用 BSx 和抗肥胖药物都需要谨慎。在这篇综述中，作者从一般和 HT 候选者的角度描述和解释了已发表的关于肥胖和减肥策略对 LVAD 患者影响的报告。作者还概述了接受 BSx 的 LVAD 接受者的历程，并回顾了围手术期方案的主要方面。