Background

Strict weight criteria exist for cardiac transplantation given the risk of allograft failure in patients with a BMI >35 kg/m2. Morbidly obese patients with advanced heart failure may undergo implantation of a left ventricular assist device (LVAD) as a bridge to transplant. These patients may benefit from metabolic and bariatric surgery (MBS) to achieve necessary weight loss to be listed for transplantation.

Methods

This is a retrospective observational study that examines the safety and efficacy of MBS for patients with morbid obesity and advanced heart failure. Inclusion criteria were patients who had undergone implantation of a left ventricular assist device and also underwent MBS. Primary outcome was listing for cardiac transplantation and secondary outcomes were 30-day surgical outcomes.

Results

Nine patients were identified who met criteria for inclusion, 3 underwent gastric bypass and 6 sleeve gastrectomy. Five patients were listed for and underwent cardiac transplantation at an average of 16 months from the time of MBS. Two other candidates have not yet achieved a BMI <35 kg/m2 and are not yet candidates for surgery. The final patient has achieved a BMI <35 but has not been listed for transplantation due to physical deconditioning. There was 1 mortality within 30 days of surgery. Five patients were readmitted and 5 received blood transfusions within 30 days.

Conclusions

While patients with advanced heart failure are high risk for MBS, this represents an effective way to achieve weight loss for morbidly obese patients to be listed for and undergo cardiac transplantation.