Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device—Case Series and Review of Literature

Abstract

For patients with advanced heart failure, left ventricular assist device (LVAD) can serve as a bridge to heart transplantation. Patients with class II obesity are eligible for implantation of LVAD, but do not meet criteria for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is proposed as weight losing modality in order to reach the NYHA criteria for listing. In our center, three patients on LVAD with need for weight reducing therapy were treated with laparoscopic sleeve gastrectomy. We reviewed our data retrospectively and compared it to the literature. Successful weight loss was achieved in all patients, without postoperative adverse events. Two out of three were listed on transplant waiting list. Our results are similar to those described in other series. BACKGROUNDLeft Ventricular Assist Device (LVAD) is a therapeutic option as bridge to orthotopic heart transplantation (OHT) in case of end stage cardiac failure. Obesity is associated with a poor outcome after OHT (1), for patients with severe obesity, it is recommended to achieve a BMI of less than 35 kg/m 2 before listing for OHT (1,2). Obesity is a worldwide expanding epidemic, in both developed and developing countries. (3,4) There is a strong association between obesity and heart failure: up to 35-43% of patients with heart failure are overweight or obese. (4-6) The Framingham heart study suggests that for every 1kg/m 2 increase in BMI the risk of developing heart failure increases by 5% in men and 7% in women. (7,8) In conclusion one can expect that more and more patients with obesity with end stage heart failure will not meet criteria for OHT due to obesity. Bariatric surgery may play a