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Background

In end-stage cardiac disease, left ventricular assist devices (LVAD) can bridge to definitive treatment via heart transplantation (HT). Given limited organ allocation, however, patients with obesity are often deemed ineligible citing increased morbidity and decreased graft survival. Existing studies indicate that sleeve gastrectomy (SG) can be safe and effective for weight loss in this setting, yet no standardized perioperative treatment algorithms exist. This study describes initial outcomes of a multidisciplinary protocol developed for management of LVAD patients undergoing SG.

Methods

A single-institution, retrospective review was conducted for LVAD patients undergoing laparoscopic SG from 2017-2021. During this period, a standardized perioperative protocol was devised and employed by bariatric and cardiothoracic surgery teams. Patient demographics, preoperative characteristics, and postoperative outcomes were collected.

Results

Seven patients, including two females, with mean age of 47.5 years (range 31-62) met criteria from 2017-2021. Average preoperative BMI was 45.1kg/m2 (39.2-54.4). Average BMI at maximum weight loss was 31.5kg/m2 (23-43.1) with average %EWL of 71.5% (35.0-111.4%). Average LOS was 4.3 days (3-7). One patient had postoperative bleeding requiring transfusion without invasive intervention. No additional in-hospital complications occurred. Regarding current transplant status, one patient proceeded to HT, one is currently listed, two are undergoing additional pre-transplant work-up, one has inadequate weight loss, and two died of unrelated, traumatic causes (intracranial bleed post-fall and motorcycle collision).

Conclusions

A multidisciplinary perioperative management protocol can be employed to standardize care and potentially improve outcomes for LVAD patients undergoing SG. Comparative effectiveness studies can further evaluate benefits of this approach.