Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant.

BACKGROUND

Obesity is an epidemic that is closely associated with heart failure. The ultimate treatment for end-stage heart failure is cardiac transplantation. Patients with morbid obesity are often excluded from receiving donor organs. Many transplant centers use body mass index (BMI) >35 kg/m as a contraindication to listing for heart transplant. Left ventricular assist devices (LVADs) were developed as a bridge to transplant for many heart failure patients, but bariatric surgery for LVAD patients has not been well described.

OBJECTIVES

The purpose of our study was to evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in LVAD patients and the impact on heart failure recovery as a bridge to cardiac transplantation.

SETTING

University hospital.

METHODS

A retrospective study was conducted to evaluate the outcomes of patients with morbid obesity and LVADs who underwent LSG at a large academic medical center between 2013 and 2017. Age, BMI, percent excess weight loss, cardiac ejection fraction, listing status for transplantation, and success of transplant were reviewed.

RESULTS

Eleven patients were identified with morbid obesity and heart failure with LVAD support who underwent LSG. There were no perioperative deaths. Four patients (37%) achieved BMI <35 and were successfully listed for and received cardiac transplantation. An additional 3 patients (27%) achieved BMI <35 kg/m and are listed for cardiac transplantation.

CONCLUSIONS

LSG can be safely used in patients with morbid obesity and end-stage heart failure requiring LVAD support to lower their BMI and become eligible for cardiac transplantation.