Laparoscopic Sleeve Gastrectomy in Patients with End Stage Heart Failure Can Be Performed Safely and Is an Effective Method of Weight Loss for Symptom Improvement and Access to Cardiac Transplantation

Aliyah Kanji, MD, Dean J Mikami, MD, Yazhini Ravi, MD, Chittoor B Sai-Sudhakar, MBBS, Robert Higgins, MD, MSHA, Brad J Needleman, MD

The Ohio State University Wexner Medical Center

INTRODUCTION: Obesity is a risk factor for the development of heart failure. Furthermore, patients with end stage heart failure and morbid obesity (BMI >35) are precluded from listing for cardiac transplantation. Bariatric surgery is an important treatment option for morbidly obese patients and has been shown to reduce cardiovascular risk and improve cardiac function. It has also been used to help patients with renal failure lose weight before and after transplant. However, it has not been widely considered in patients with end-stage heart disease and obesity due to the increased risk of surgery. Longitudinal sleeve gastrectomy may become a reasonable treatment option for patients with obesity, heart failure and left ventricular assist devices to help lose adequate weight to qualify for transplantation.

METHODS AND PROCEDURES: We performed a retrospective review of our experience with laparoscopic sleeve gastrectomy for morbid obesity in 4 patients with severe heart failure; 3 of the 4 patients had left ventricular assistive devices (LVAD) in place. Standard laparoscopic sleeve gastrectomy was performed using 34-42F bougie, performed by a single surgeon at our institution. Patient age, BMI, cardiac diagnosis, operative data, complications, weight loss and cardiac outcomes were collected on all of the patients.

RESULTS: Between 2008 and present, a total of 4 patients with end stage heart failure have undergone laparoscopic sleeve gastrectomy. Patient age ranged from 31-66 years. Mean BMI was 47kg/m2 (range 43-51). Three patients had end stage heart failure with LVAD in place, the 4th patient required an RVAD but could not be performed for technical reasons. One patient suffered a post operative complication of flank hematoma managed non-operatively and LVAD thrombosis 3 weeks after surgery. Mean follow-up was 32 months (0-48). Mean BMI post operatively was 33 kg/m2 and mean weight lost was 44kg (27-59kg). One patient was successfully transplanted 1 year post surgery, 2 patients are currently being considered for transplant. The 4th patient had adequate symptom control from weight loss and continues to be managed medically for heart failure.

CONCLUSION: Laparoscopic sleeve gastrectomy may be considered a safe and effective treatment for morbid obesity in patients with end stage heart failure for symptom control and access to cardiac transplantation.

Session: Poster Presentation

Program Number: P445

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