Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analys
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Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis Jothika Challapalli 1 & Elizabeth J. Maynes 2 & Thomas J. O’Malley 2 & Devon E. Cross 2 & Matthew P. Weber 2 & Jae Hwan Choi 2 & Rajesh Aggarwal 3 & Andrew J. Boyle 4 & David J. Whellan 4 & John W. Entwistle 2 & H. Todd Massey 2 & Rohinton J. Morris 2 & Vakhtang Tchantchaleishvili 2 Received: 23 August 2019 / Revised: 28 June 2020 / Accepted: 2 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose A body mass index (BMI) > 35 kg/m2 is a relative contraindication to heart transplantation in patients with end-stage heart failure. Bariatric surgery can be considered either concomitantly with continuous-flow left ventricular assist device (CFLVAD) placement, or staged after CF-LVAD has been placed. We sought to evaluate the outcomes of these approaches. Materials and Methods An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight studies were pooled for systematic review and metaanalysis. Results Overall, of 59 patients, 22 (37%) underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while 37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age of patients was 46 years (95% CI: 39–53) with 40% females. Mean BMI at most recent follow-up (33.4 kg/m2, 95% CI: 30.2–36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m2, 95% CI: 42.9–50.6) (p < 0.01). There was no significant difference in total incidence of postoperative complications (simultaneous, 16% (95% CI: 1–87%) versus staged, 23% (95% CI: 7–53%)) or in overall survival (simultaneous, 93% (95% CI: 72–99%) versus staged, 79% (95% CI: 60–90%), p = 0.17) for average follow-up time of 12.7 months. Bariatric surgery resulted in 66% of patients (95% CI: 51–79) to be listed for heart transplantation, including 33% (95% CI: 22–47) who were transplanted. Conclusions Both simultaneous and staged bariatric surgeries with CF-LVAD placement have comparable outcomes and significantly reduce BMI. This can allow previously ineligible patients to undergo heart transplantation. Keywords Left ventricular assist device . Bariatric surgery . Bridge to transplantation
Introduction Obesity has become one of most serious health issues in the USA and is now considered a national epidemic. The 2015– 2016 CDC National Center for Health Statistics reports the crude prevalence of obesity among US adults aged 20 and * Vakhtang Tchantchaleishvili [email protected] 1
Drexel University College of Medicine, Philadelphia, PA, USA
2
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
3
Division of Minimally Invasive, Metabolic, and Bariatric Surgery, Thomas Jefferson University, Philadelphia, PA, USA
4
Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
over as 39.8%, which means obesi
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