Bariatric surgery in patients with left ventricular assist devices

a safe and effective method of weight loss as a gateway to heart transplantation

Ariela Zenilman, David Pechman, Erin Moran-Atkin, Jenny J. Choi, Diego Camacho

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StateAccepted/In press - Jan 1 2019

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Heart-Assist Devices
Bariatric Surgery
Heart Transplantation
Weight Loss
Gastrectomy
Length of Stay
Morbidity
Transplants
Sample Size
Heart Diseases
Body Mass Index
Transplantation
History
Quality of Life
Weights and Measures

Keywords

  • Bariatric surgery
  • Heart transplantation
  • Left ventricular assist device
  • Perioperative complications
  • Sleeve gastrectomy
  • Weight loss surgery

ASJC Scopus subject areas

  • Surgery

Cite this

@article{47deb82d5e634b148e03f638a93a3e90,
title = "Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation",
abstract = "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.",
keywords = "Bariatric surgery, Heart transplantation, Left ventricular assist device, Perioperative complications, Sleeve gastrectomy, Weight loss surgery",
author = "Ariela Zenilman and David Pechman and Erin Moran-Atkin and Choi, {Jenny J.} and Diego Camacho",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.soard.2019.08.003",
language = "English (US)",
journal = "Surgery for Obesity and Related Diseases",
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TY - JOUR

T1 - Bariatric surgery in patients with left ventricular assist devices

T2 - a safe and effective method of weight loss as a gateway to heart transplantation

AU - Zenilman, Ariela

AU - Pechman, David

AU - Moran-Atkin, Erin

AU - Choi, Jenny J.

AU - Camacho, Diego

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Bariatric surgery

KW - Heart transplantation

KW - Left ventricular assist device

KW - Perioperative complications

KW - Sleeve gastrectomy

KW - Weight loss surgery

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SN - 1550-7289

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