title: Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results.
abstract: BACKGROUND
  Morbid obesity precludes patients with end-stage heart failure from becoming cardiac transplant candidates. This study evaluates the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) as a means to transplant candidacy in such patients.
  
  
  METHODS
  Morbidly obese patients with end-stage heart failure, who were ineligible for cardiac transplantation and underwent LSG between 2008 and 2013, were reviewed retrospectively. Demographic characteristics, perioperative details, percentage of excess weight loss (%EWL), and status of transplant candidacy were analyzed.
  
  
  RESULTS
  Six patients (3 men) with end-stage heart failure and morbid obesity underwent LSG. Three patients (50%) had a left ventricular assist device (LVAD) in place at the time of surgery. Median age was 34 (31-66) years and mean preoperative body mass index (BMI) was 47.6±3.0 kg/m2. Median operative time was 90 (66-141) minutes, with a median length of stay of 7 (4-16) days. There were no perioperative deaths. One patient suffered a spontaneous flank hematoma. The same patient also had thrombosis of the LVAD pump at 3 weeks postoperatively, requiring an uneventful device exchange. At median follow-up of 22 (12-70) months, the mean %EWL was 51.4±10.3% with a decrease in BMI to 34.3±2.4 kg/m2 (P<.05). All patients had lost sufficient weight to become transplant eligible within 12 months of surgery. Two patients had undergone successful transplantation and another 2 were on the transplant list.
  
  
  CONCLUSIONS
  LSG appears to be a safe, technically feasible, and effective method for obtaining adequate weight loss in morbidly obese patients with end-stage heart failure and mechanical circulatory support, subsequently improving their access to cardiac transplantation. This is the largest case series to date of this high-risk group of patients undergoing LSG.
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Umer I
authors.initials: UI
authors.lastname: Chaudhry
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Aliyah
authors.initials: A
authors.lastname: Kanji
authors.affiliation: Heart Transplantation Center, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Chittoor B
authors.initials: CB
authors.lastname: Sai-Sudhakar
authors.affiliation: Heart Transplantation Center, The Ohio State University Wexner Medical Center, Columbus, Ohio.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Higgins
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. Electronic address: bradley.needleman@osumc.edu.
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Needleman
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006333:Heart Failure / Q000150:complications* / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Cardiac transplantation; Heart failure; Laparoscopic sleeve gastrectomy; Left ventricular assist device; Morbid obesity