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

Abstract

Heart transplant is the primary treatment for end-stage heart failure; however, morbid obesity limits candidacy. Bariatric surgery performed in patients with advanced heart failure improves eligibility for heart transplantation. This is the first report of an intra-aortic balloon pump used during laparoscopic sleeve gastrectomy. A patient with morbid obesity and non-ischemic cardiomyopathy was referred for weight loss surgery prior to evaluation for heart transplantation. An intra-aortic balloon pump was placed for aggressive diuresis and cardiovascular support during laparoscopic sleeve gastrectomy. The patient did not suffer any complications or require readmission. The use of an intra-aortic balloon pump as a mechanical circulatory system provided a safe laparoscopic sleeve gastrectomy in a patient with advanced heart failure.

Bariatric Surgery Using Intra-Aortic Balloon Pump in Advanced Heart Failure as Bridge to Heart Transplant

“…This patient has biventricular heart failure that prevented him from receiving an LVAD, and he was able to successfully undergo a laparoscopic vertical sleeve gastrectomy bariatric procedure on inotropic support using an intra-aortic balloon pump. The use of an intra-aortic balloon pump during sleeve gastrectomy in a patient without an LVAD has only been described once in a case report, 3 but on a smaller patient with a BMI of 45. Our experience suggests that with postoperative management on an advanced heart failure cardiology service, intraoperative interventions such as staple line reinforcement and drain placement to reduce the risk for takeback operations, and the use of an intraoperative balloon pump, advanced heart failure patients may be able to successfully and safely undergo Bariatric surgery to lose weight and trend toward listing for heart transplant.…”

Metabolic and bariatric surgery

“…The Special Issue "Metabolic and Bariatric Surgery" covers the essentials of technique and perioperative care. The Special Issue is also the first to report the use of intra-aortic balloon pump (IABP) [9] during sleeve gastrectomy and complication of patulous eustachian tube (PET) [10] after sleeve gastrectomy. Bariatric surgeons have known for a long time that metabolic operations reverse many comorbid conditions.…”