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/m² 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/m² 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.