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LAPAROSCOPIC SLEEVE GASTRECTOMY AS A BRIDGE TO CARDIAC TRANSPLANTATION

Claire L Donohoe, MD, PhD, S G Mattar, MD, Donn Spight, MD, Farah A Husain, MD. OHSU

Introduction: Body mass index >35kg/m2 is a contraindication to placement on the cardiac transplant list. Patients with morbid obesity and end stage cardiac failure may require bariatric surgery in order to access this life-saving procedure.

Methods: We performed a retrospective assessment of the outcomes of consecutive morbidly obese patients who underwent laparoscopic sleeve gastrectomy who would otherwise meet eligibility for cardiac transplantation.

Results: 4 male patients (age range 28-56 years) underwent laparoscopic sleeve gastrectomy over the period 2016-17. All patients had a left ventricular ejection fraction of less than 15%, one secondary to ischemic cardiomyopathy and the other 3 with familial non-ischemic cardiomyopathy. Two patients had an ICD in situ and the other two had left ventricular assist devices in place at the time of surgery.  One patient had previously had a gastric band placed with no weight loss over two years following this procedure.

The median BMI at time of surgery was 51.4 kg/m2 (range 42.8-61.6). The median length of stay was 5.5 days (range 4-7 days). None of the patients experienced a post-operative complication despite significant co-morbidities in this cohort including hepatitis C related cirrhosis, haemophilia A, previous stroke, previous pulmonary embolism and poorly controlled type 2 diabetes. The median percentage weight loss at 1 year post surgery was 72.2% (range 48.4-88.2%). Two patients successfully underwent cardiac transplant at 8 and 18 months post-op; the other two continue to but have noted a stabilisation of cardiac physiology and improved functional capacity with weight loss.

Conclusions: Careful multi-disciplinary management of patients requiring weight loss in order to qualify for cardiac transplantation is feasible and safe with good intermediate outcomes.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87902

Program Number: P612

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

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