Sara A Morrison, MD, Amanda Vest, MD, Roman Schumman, MD, Sajani N Shah, MD. Tufts Medical Center
Introduction: Morbid obesity frequently precludes advanced heart failure patients from transplant eligibility. Transplant centers have strict BMI restrictions for candidacy on organ waiting lists, and additionally a relative size match is required between cardiac donors and recipients, further limiting a patient’s ability to be transplanted if they are significantly overweight. Obese potential donors who may be a size match to our patient cohort are more likely to have hearts that are not suitable for transplantation. Our aim was to determine if bariatric surgery is effective for meaningful weight loss in advanced heart failure patients, and thus establish their cardiac transplant eligibility.
Methods: We performed a retrospective study including end stage heart failure patients not eligible for transplant listing secondary to morbid obesity that underwent laparoscopic sleeve gastrectomy (LSG) at a single institution from 2013 – present. Patient demographics, operating time, length of stay, complications, weight loss, changes in medications, and transplant status were reviewed. Results were analyzed by student’s t-test.
Results: Five patients with advanced heart failure underwent LSG, four of whom had a left-ventricular assist device in place. Mean age was 40.8 (26 – 53), Mean operating time was 83.5 minutes (66-102 minutes), average length of stay post-operatively was five days (3-8 days). There was a median follow up time of 7.5 months (3 – 42months). Mean excessive weight loss at the patient’s last visit was 48.83% (77.45% – 26.44%), with an average decrease in BMI of 11.16 +/- 3.85 kg/m2 (p=0.01). Secondary to modification of the stomach and alteration of gastric flora, dosing changes may be necessary in oral medications following LSG. We found patients uniformly required decreased dosing of Coumadin after LSG, with an average daily dose reduction of 36.44%. We had one mortality, related in part to supra-therapeutic anticoagulation perioperatively. One patient underwent successful heart transplantation and 2 additional patients were reactivated on the transplant list.
Conclusion: Laparoscopic sleeve gastrectomy is effective in advanced heart failure patients for meaningful weight loss, reactivation to the transplant wait list, and ultimately cardiac transplantation. However, this complex population carries a high perioperative risk and close multidisciplinary collaboration is required. More data is needed to best optimize perioperative management of these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87472
Program Number: P620
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster