If you take a look at the "Keymap issues with Alt" VsVim issue on GitHub, you will see that (as of this writing) VsVim does not support mappings with ALT in them. (Are you sure your ALT-= binding is working? I tried it with no success.) Apparently it is non-trivial to capture these keys in Visual Studio. Jared commented on that issue:
Spent some time talking with the owners of keyboard routing in Visual Studio. They've assured me there is really no way to intercept the Alt key from an extension. It's possible in some limited scenarios (controlling the IVsWindowPane) but it's not generally a supported feature.
This really puts me in a corner. I believe I could still fake this behavior by switching VsVim to a package, registering DTE.Command objects which are bound to Alt and intercepting them that way. This is a rather large change though.
That is an old comment, and since then, he has switched VsVim to be a full package. However, it seems that he has not fixed the Alt issue as of this writing.