Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysi
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Laparoscopic Sleeve Gastrectomy in Patients with Obesity and Ventricular Assist Devices: a Comprehensive Outcome Analysis Adrian daSilva-deAbreu 1,2,3 & Kiran Garikapati 1,2 & Bader Aldeen Alhafez 4 Selim Krim 1,2 & Hamang Patel 1,2 & Hector O. Ventura 1,2 & Carl J. Lavie 1,2 Stacy A. Mandras 1,2
Sapna Desai 1,2 & Clement Eiswirth 1,2 & 3 & Juan Francisco Loro-Ferrer & &
Received: 3 July 2020 / Revised: 19 August 2020 / Accepted: 19 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We analyzed in detail the outcomes of eight patients with ventricular assist devices (VADs) and obesity who underwent laparoscopic sleeve gastrectomy (LSG) at a single heart transplant (HT) center. This comprehensive analysis included body mass index (BMI) trends from VAD implantation to the time of LSG; BMI and percentage of excess BMI lost during follow-up; adverse outcomes; and changes in echocardiographic parameters, fasting lipids, unplanned hospitalizations, and functional status. We also identified the patients who achieved the following outcomes: listing for HT, HT, 50% excess BMI loss, and BMI < 35 kg/m2. Laparoscopic sleeve gastrectomy seems to be a reasonable and effective intervention to help patients with VADs and obesity to decrease excess BMI and become candidates for HT. Keywords Laparoscopic sleeve gastrectomy . Sleeve gastrectomy . Bariatric surgery . Heart failure . End-stage heart failure . Ventricular assist devices . Heart-assist devices
Introduction Obesity is a major comorbidity in patients with end-stage heart failure, not just as it poses significant cardiovascular risk but also as it is associated with worse outcomes after implantation of ventricular assist devices (VADs) and heart transplantation (HT). Hence, a body mass index (BMI) ≥ 35 kg/ m2 represents an important contraindication for HT [1]. This represents a problem for many patients with end-stage heart failure, including those who undergo VAD implantation as destination therapy after being rejected for HT due to obesity, and those who receive a VAD as a bridge to HT but gain * Adrian daSilva-deAbreu [email protected] 1
John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA, USA
2
The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA, USA
3
Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
4
Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
weight while awaiting transplantation, a common phenomenon after VAD implantation [2]. This has motivated programs of advanced heart failure and heart transplantation to consider bariatric surgery as a means to help patients achieve enough weight loss to become HT candidates. Several small studies have demonstrated interesting results about the role of bariatric surgery in patients with VADs [3–5]. However, while most of these studies have tried to assess the outcomes of laparoscopic sle
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