Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030.
Bariatric and Metabolic Surgery Center, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030.
Tex Heart Inst J. 2020 Aug 1;47(4):284-289. doi: 10.14503/THIJ-19-7161.
Bariatric surgery helps many morbidly obese patients lose substantial weight. However, few data exist on its long-term safety and effectiveness in patients who also have continuous-flow left ventricular assist devices and in whom heart transplantation is contemplated. We retrospectively identified patients at our institution who had undergone ventricular assist device implantation and subsequent laparoscopic sleeve gastrectomy from June 2015 through September 2017, and we evaluated their baseline demographic data, preoperative characteristics, and postoperative outcomes. Four patients (3 men), ranging in age from 32 to 44 years and in body mass index from 40 to 57, underwent sleeve gastrectomy from 858 to 1,849 days after left ventricular assist device implantation to treat nonischemic cardiomyopathy. All had multiple comorbidities. At a median follow-up duration of 42 months (range, 24-47 mo), median body mass index decreased to 31.9 (range, 28.3-44.3) at maximal weight loss, with a median percentage of excess body mass index lost of 72.5% (range, 38.7%-87.4%). After achieving target weight, one patient was listed for heart transplantation, another awaited listing, one was kept on destination therapy because of positive drug screens, and one regained weight and remained ineligible. On long-term follow-up, laparoscopic sleeve gastrectomy appears to be safe and feasible for morbidly obese patients with ventricular assist devices who must lose weight for transplantation consideration. Additional studies are warranted to evaluate this weight-loss strategy after transplantation and immunosuppression.
减重手术有助于许多病态肥胖患者显著减轻体重。然而，在同时患有连续流左心室辅助装置且考虑进行心脏移植的患者中，关于其长期安全性和有效性的数据很少。我们回顾性地确定了我们机构中在 2015 年 6 月至 2017 年 9 月期间接受心室辅助装置植入和随后腹腔镜袖状胃切除术的患者，并评估了他们的基线人口统计学数据、术前特征和术后结果。4 名患者（3 名男性）年龄在 32 岁至 44 岁之间，体重指数在 40 至 57 之间，在左心室辅助装置植入后 858 至 1849 天进行了袖状胃切除术，以治疗非缺血性心肌病。所有患者均有多种合并症。在中位数为 42 个月（范围，24-47 个月）的随访期间，最大减重时体重指数中位数降至 31.9（范围，28.3-44.3），体重指数多余百分比中位数丢失为 72.5%（范围，38.7%-87.4%）。达到目标体重后，1 名患者被列入心脏移植名单，另 1 名患者等待列入名单，1 名患者因药物检测阳性而继续接受目的地治疗，1 名患者体重增加且仍不符合条件。在长期随访中，腹腔镜袖状胃切除术似乎对必须为移植考虑而减肥的患有心室辅助装置的病态肥胖患者是安全且可行的。需要进一步的研究来评估这种在移植和免疫抑制后的减重策略。
