Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device

Abstract

Background: There is limited data in the literature evaluating outcomes of bariatric surgery in severely obese patients with left ventricular assist device (LVAD) as a bridge to make them acceptable candidates for heart transplantation. This study aims to assess the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients with previously implanted LVAD at our institution. Methods: All the patients with end-stage heart failure (ESHF) and implanted LVAD who underwent LSG from2013 to January 2017 were studied. Results: Seven patients with end stage heart failure (ESHF) and implanted LVAD were included. The median age and median preoperative BMI were 39 years (range: 26-62) and 43.6 kg/m2 (range 36.7-56.7), respectively. The median interval between LVAD implantation and LSG was 38 months (range 15-48). The median length of hospital stay was 9 days (rang: 6-23) out of which 4 patients had planned postoperative ICU admission. Thirty-day complications were noted in 5 patients (3 major and 2 minor) without any perioperative mortality. The median duration of follow-up was 24 months (range 2-30). At the last available follow-up, the median BMI, %EWL, and %TWL were 37 kg/m2 , 47%, and 16%, respectively. The median LVEF before LSG and at the last follow-up point (before heart transplant) was 19% (range 15-20) and 22% (range, 16-35), respectively. In addition, the median NYHA class improved from 3 to 2 after LSG. Three patients underwent successful heart transplantations. Conclusion: Patients with morbid obesity, ESHF, and implanted LVAD constitute a high-risk cohort. Our results with 7 patients and result from other studies (19 patients) suggested that bariatric surgery may be a reasonable option for LVAD patients with severe obesity. Bariatric surgery appears to provide significant weight loss in these patients and may improve candidacy for heart transplantation.

Use of an intra-aortic balloon pump during laparoscopic sleeve gastrectomy

“…Bariatric surgery in patients with severe cardiomyopathy, including LVAD, is an opportunity for rapid weight loss as a "bridge" to transplantation. Studies of small cohorts show patients with LVAD who underwent bariatric surgery had improvement in median left ventricular ejection fraction and reduction in NYHA classification [6,10] . In particular, Punchai et al [6] reported on three patients with LVAD who went on to receive a heart transplant after LSG.…”

“…Studies of small cohorts show patients with LVAD who underwent bariatric surgery had improvement in median left ventricular ejection fraction and reduction in NYHA classification [6,10] . In particular, Punchai et al [6] reported on three patients with LVAD who went on to receive a heart transplant after LSG. Acceptable rates of complications included five perioperative morbidities and two deaths from LVAD complications.…”

“…Preoperative testing included an upper gastrointestinal series that revealed normal esophageal motility, no hiatal hernia, and no gastroesophageal reflux. LSG was chosen over Rouxen-Y gastric bypass for technical ease, shorter operative time, perioperative safety profile, and effective weight loss in end-stage HF patients [5][6][7] .…”

Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note

“…Bariatric surgery is an option for patients with VADs to lose weight and improve HT candidacy, with some studies reporting promising results [ 5 – 7 ]. Over the last years, laparoscopic sleeve gastrectomy (LSG) has become the preferred bariatric surgery for obese patients with VADs due to its effectiveness and safety profile [ 8 ].…”

Bariatric surgery in obese patients with ventricular assist devices

“…Few small cohort studies and case reports have shown promising results of bariatric surgery (BS) in obese patients with VADs [3][4][5][6]. Nevertheless, much of the postoperative weight (and BMI) trends remains unknown in this population.…”