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Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device

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Abstract

Background

There is limited data in the literature evaluating outcomes of bariatric surgery in severely obese patients with left ventricular assist device (LVAD) as a bridge to make them acceptable candidates for heart transplantation. This study aims to assess the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in patients with previously implanted LVAD at our institution.

Methods

All the patients with end-stage heart failure (ESHF) and implanted LVAD who underwent LSG from2013 to January 2017 were studied.

Results

Seven patients with end stage heart failure (ESHF) and implanted LVAD were included. The median age and median preoperative BMI were 39 years (range: 26–62) and 43.6 kg/m2 (range 36.7–56.7), respectively. The median interval between LVAD implantation and LSG was 38 months (range 15–48). The median length of hospital stay was 9 days (rang: 6–23) out of which 4 patients had planned postoperative ICU admission. Thirty-day complications were noted in 5 patients (3 major and 2 minor) without any perioperative mortality. The median duration of follow-up was 24 months (range 2–30).

At the last available follow-up, the median BMI, %EWL, and %TWL were 37 kg/m2, 47%, and 16%, respectively. The median LVEF before LSG and at the last follow-up point (before heart transplant) was 19% (range 15–20) and 22% (range, 16–35), respectively. In addition, the median NYHA class improved from 3 to 2 after LSG. Three patients underwent successful heart transplantations.

Conclusion

Patients with morbid obesity, ESHF, and implanted LVAD constitute a high-risk cohort. Our results with 7 patients and result from other studies (19 patients) suggested that bariatric surgery may be a reasonable option for LVAD patients with severe obesity. Bariatric surgery appears to provide significant weight loss in these patients and may improve candidacy for heart transplantation.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, M61, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Suriya Punchai, Zubaidah Nor Hanipah, Gautam Sharma, Ali Aminian, Stacy A. Brethauer & Philip R. Schauer

  2. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Suriya Punchai

  3. Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia

    Zubaidah Nor Hanipah

  4. Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA

    Karen Steckner & Jacek Cywinski

  5. Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA

    James B. Young

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  1. Suriya Punchai
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  2. Zubaidah Nor Hanipah
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  4. Ali Aminian
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  8. Stacy A. Brethauer
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  9. Philip R. Schauer
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Corresponding author

Correspondence to Philip R. Schauer.

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Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and /or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This study does not require informed consent.

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The authors declare that they have no conflict of interest.

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Punchai, S., Nor Hanipah, Z., Sharma, G. et al. Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device. OBES SURG 29, 1122–1129 (2019). https://doi.org/10.1007/s11695-018-3570-8

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  • DOI: https://doi.org/10.1007/s11695-018-3570-8

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