Ariela L Zenilman, MD, Diego R Camacho, MD, FACS, Jenny Choi, MD, Erin Moran-Atkin, MD. Montefiore Medical Center
Introduction: Severe cardiac disease often warrants mechanical support via a left ventricular assist device to improve cardiac function. While this is an effective way of improving myocardial activity, it works synergistically with weight loss. Studies have suggested that for every 1-kg/m2 increase in BMI, the risk of developing heart failure increases 5% in men and 7% in women. Obesity, a known risk factor for CAD, alters lipid metabolism leading to atherosclerosis and ischemic cardiomyopathy. In terms of cardiac transplantation, mortality rates are significantly higher in patients with BMI>35. Data shows that patients that lose at least 3kg have a significant improvement in LVEF, NYHA class, and quality of life. While other studies have shown that myocardial function in this population has improved following weight reduction surgery, this study looks specifically at patients with LVADs in place. This study aims to show that bariatric surgery is effective and safe, achieving weight loss goals and providing a bridge to transplantation in patients with LVADs.
Methods: After obtaining IRB approval, EMR was reviewed for patients with morbid obesity, defined as BMI >35 with obesity related health conditions, who have LVADs due to depressed cardiac function. Four patients in this group underwent bariatric surgery at Montefiore Medical Center in order to achieve satisfactory weight loss goals.
Results: Each patient underwent a Laparoscopic Sleeve Gastrectomy (LSG). Due to significant comorbidities, patients were admitted to the hospital pre-operatively for optimization and management of anticoagulation. Average length of stay post LSG in this group was 4.5 days. Complications post-operatively showed to be related to anticoagulation of the patient. In terms of weight loss analysis, BMI and improvement in health conditions were followed after LSG. Each patient experienced a significant decrease in BMI with end goal of transplantation. Patient 1 and 2 underwent cardiac transplantation within 1 year of LSG. Patient 3 has completed assessment and deemed a transplant candidate at BMI of 32. Six weeks after LSG, patient 4's BMI reduced to 36 from 41, showing promise of transplant candidacy.
Conclusion: Patients with multiple medical problems, not limited to cardiac disease requiring LVADs, can achieve weight loss goals safely by surgical means despite poor surgical candidacy. Complications post LSG were minimal and no different from the other patient groups. While limitations of sample size prevent statistical analysis, this study demonstrates promising outcomes for this high risk group in terms of a gateway to transplantation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84855
Program Number: P645
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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