Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation.

BACKGROUND

Severe cardiac disease often warrants intervention to improve cardiac function, such as mechanical support via a left ventricular assist device (LVAD). While this is an effective way of improving myocardial activity, it works synergistically with weight loss.

SETTING

Academic hospital.

OBJECTIVE

The aim of this study was to evaluate bariatric surgery as an alternative means of weight loss to improve cardiac status.

METHODS

Six patients with LVADs underwent sleeve gastrectomies (SG) over a 5-year study period (2014-2018). Patient characteristics, cardiac history, operative outcomes, and follow-up was evaluated by univariate analyses.

RESULTS

Median age at operation was 49.8 years (range, 24-58 yr) with average weight at surgery of 126.6 kg. Average body mass index at time of SG was 41.4 kg/m2. Median hospital length of stay was 8.5 days (range, 4-13 d), with postoperative length of stay of 5.5 days (3-7 d). Total follow-up was 29 months (range, 7-51 mo). Postoperative readmission occurred in 2 patients (33%) without significant adverse outcomes. Four patients (67%) were listed for transplant, 3 within 1 year of LSG. Three patients (50%) underwent orthotopic heart transplant. All patients experienced improved cardiac co-morbidities after SG.

CONCLUSION

We demonstrate that weight loss surgery as a bridge to transplantation for patients with implanted LVADs can be performed in young and middle-aged adults. Although it is limited by sample size, the reported results add to the existing literature highlighting the potential success of bariatric surgery in high-risk patient populations to achieve weight loss goals, impact cardiac co-morbidities, and improve overall quality of life.