Left ventricular assist devices (LVADs) are slowly gaining acceptance as the treatment of choice in appropriately selected patients with end-stage heart failure who are not transplant candidates. Obesity is a well-known risk factor for increased cardiovascular morbidity and mortality, and frequently can be the reason some patients are turned down for heart transplantation. Because of this experience in transplant patients, many centers have also been reluctant to offer these patients an LVAD for destination therapy (DT). Subsequently, the 1-year outcomes of obese patients receiving LVADs for DT at our center were reviewed. Fifty-eight consecutive patients (83% men) were implanted with HeartMate XVE (n = 22) or HeartMate II (n = 36) LVAD. Patients were divided into normal (body mass index [BMI] or= 30 kg/m(2), n = 20) groups according to their BMI. Preoperatively, there were statistically significant differences (P < 0.05) between normal and obese groups in age (65.9 years vs. 54.7 years), weight (72.9 kg vs. 107.5 kg), BMI (24.1 kg/m(2) vs. 35.2 kg/m(2)), and incidence of diabetes (37% vs. 60%). At 1-year follow-up, there were no statistically significant differences (P > 0.5) between normal and obese groups: creatinine levels (1.4 vs. 1.5), New York Heart Association classification (1.2 vs. 1.6), and survival (63% vs. 65%). Our initial results demonstrate that morbidly obese patients with end-stage heart failure with a contraindication for transplant may successfully undergo implantation of an LVAD for DT.
A 19-year-old 250-kg Quarter Horse mare was examined in the fall for evaluation of weight loss of 4 years' duration. The mare had been purchased 6 years before examination and was reported to be normal in appearance, weight, and demeanor. She had been used for trail riding. The owner initially noticed weight loss following transient postpartum diarrhea 4 years before presentation. The weight loss was mild and slowly progressed with intermittent periods of soft feces. Referral for evaluation was prompted by marked weight loss over the preceding 6 months. The mare had a ravenous appetite and polydipsia. In addition, the mare did not completely shed her hair coat during summer and was heat intolerant in ambient temperatures that exceeded 32.2 1C (901F). This was manifested as lethargy, sweating, and increased respiratory rate.Because of incomplete hair coat shedding and suspicion of pars intermedia hyperplasia, a dexamethasone suppression test had been performed in the fall, 5 years before presentation. This revealed incomplete suppression of serum cortisol to 59% of baseline at 15 hours (144
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