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.