Laparoscopic Sleeve Gastrectomy in Patients with Ventricular Assist Devices, Beyond Just Bridging to Heart Transplantati
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LETTER TO THE EDITOR
Laparoscopic Sleeve Gastrectomy in Patients with Ventricular Assist Devices, Beyond Just Bridging to Heart Transplantation Adrian daSilva-deAbreu 1,2,3 & Bader Aldeen Alhafez 4 & Hamang Patel 1,2 Hector O. Ventura 1,2 & Carl J. Lavie 1,2 & Stacy A. Mandras 1,2
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Juan Francisco Loro-Ferrer 3
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Received: 30 July 2020 / Revised: 3 August 2020 / Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
We read with interest the study of Van Aelst et al. [1], who described the outcomes of the three patients with ventricular assist devices (VADs) after undergoing laparoscopic sleeve gastrectomy (LSG) with the intention of improving their candidacy for heart transplantation (HT). In their series, two of the three patients lost enough weight and were listed for HT, while the third one did not achieve such endpoint due to behavioral contraindications. Although their high success rate (of listing for HT) is similar to what has been observed in other cohorts with higher preoperative body mass indices (BMIs) [2–4], their patients had a relatively short hospital stay and no adverse events. These results confirm the important role of LSG as part of weight loss programs for patients with VADs who are rejected for HT due to class II or III obesity (BMI ≥ 35 kg/m2) [5]. However, we suspect that LSG can benefit this patient population beyond improving transplant candidacy, as some patients with VADs have experienced myocardial recovery with significant weight loss after LSG [6, 7]. Furthermore, life expectancy of patients with VADs has improved over the last years; hence, they may survive long enough to enjoy the metabolic, functional, and psychosocial benefits of bariatric surgery observed in the general heart failure population [8],
although no study has addressed these outcomes in patients with VADs. Some major challenges for bariatric studies of patients with VADs are the low sample sizes in each center; heterogeneity of protocols for perioperative management, including anticoagulation; complex comorbidities of these patients; and paucity of programs that perform bariatric surgery in patients with VADs. These challenges could be addressed with the creation of a prospective multicenter registry and, ideally, with multicenter clinical trials. For either or both to happen, bariatric surgeons, as well as cardiologists and cardiac surgeons specialized in VADs and HT need to unify criteria for definition of the most relevant variables for these patients. Thus far, much remains unknown about non-transplant outcomes of patients with VADs who undergo LSG or other types of bariatric surgeries. Although available literature provides insight into objective, standard, major outcome data (HT, listing for HT, mortality, etc.), additional simple and easily available information could also provide valuable knowledge to bariatric surgeons, as well as cardiologists and cardiac surgeons specialized in VADs and HT. When feasible, future studies should include well-defined and standard
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