Bariatric surgery in patients with ventricular assist devices: a matched analysis of MBSAQIP.

BACKGROUND

Patients with obesity and heart failure managed with ventricular assist devices (VADs) are a medically complex population who could benefit from metabolic and bariatric surgery (MBS), but are often considered prohibitively high risk.

OBJECTIVES

We wished to report the outcomes following MBS in patients with VADs in a contemporary North American cohort.

SETTING

Accredited MBSAQIP centers in United States and Canada in 2022.

METHODS

We used the 2022 MBSQIP participant user file (PUF) to identify all patients who had a preoperative ventricular assist device. We reported the baseline characteristics, hospitalization course, 30-day complications, and weight loss outcomes. We performed 1:1 nearest neighbor Mahalanobis distance matching without replacement to identify patients with similar comorbidities, and used g-computation to estimate the independent effect of VAD therapy on key outcomes.

RESULTS

Of the 120 patients undergoing MBS with a history of VAD, 78 underwent sleeve gastrectomy and 17, Roux-en-Y gastric bypass. The median postoperative length of stay was 2 days, and with 119 patients surviving to hospital discharge, the overall 30-day risk of death was .8%. There were no recorded pulmonary embolism, stroke, cardiac arrest, or myocardial infarction events. Compared to their matched counterparts, VAD patients had an increased risk of length of stay >7 days (risk ratio 1.40, 95% CI: .91-2.14) and required more units of blood transfusion (mean difference .19, 95% CI: .06-.32). VAD therapy was not statistically significantly associated with an increased risk of death (risk ratio 1.04, 95% CI .76-1.42).

CONCLUSIONS

Early outcomes after bariatric surgery in patients with VADs suggest feasibility and safety. Larger studies with well-defined selection criteria and longer term follow up are needed to confirm these results.