Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation

Zenilman, Ariela; Pechman, David; Moran-Atkin, Erin; Choi, Jenny; Camacho, Diego

doi:10.1016/j.soard.2019.08.003

Cited by 25 publications

(12 citation statements)

References 17 publications

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“…While coordination with structured weight loss programs or even bariatric surgery is not standard at our center, these strategies may improve the success of this approach. 23,24…”

Section: Discussionmentioning

confidence: 99%

“…While coordination with structured weight loss programs or even bariatric surgery is not standard at our center, these strategies may improve the success of this approach. 23,24 Patients treated with a BTC strategy for social contraindications to HTx had the lowest overall rates of HTx and the highest rates of hospital readmission. Of note, 21% of patients in the BTC-Soc group underwent a durable biventricular support device as a BTC strategy.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

Zaliznyak

Stern²,

Cole³

et al. 2021

ASAIO Journal

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Durable mechanical circulatory support (dMCS) devices can be offered as a bridge-to-transplant (BTT) or as a bridge-to-candidacy (BTC) strategy for candidates with contraindications to transplant listing, including pulmonary hypertension (BTC-PH), morbid obesity (BTC-Obes), social issues (BTC-Soc), or chronic illness (BTC-Illness). An understanding of the trajectory of BTC patients could guide future triage of advanced heart failure patients who are not candidates for transplantation. We performed a retrospective review all patients who underwent dMCS implantation as either BTT (206 patients) or BTC (114 patients) at our center from January 1, 2010, to March 31, 2020. There was no significant difference in mortality between BTC patients and BTT patients. Compared with the BTT group, significantly more patients in the BTC-PH group were transplanted (81% vs. 63%; p < 0.05) and significantly fewer patients in the BTC-Obes group (44%; p < 0.05) and BTC-Soc group (39%; p < 0.05) were transplanted. Additionally, the readmission rate was higher for those in the BTC-Obes (6.2 vs. 2.1; p < 0.05) and BTC-Soc (3.9 vs. 2.1; p < 0.05) groups. Bridge-to-candidacy patients generally had poorer post-dMCS trajectories than BTT patients. Centers should not be dissuaded from pursuing a BTC strategy for qualified patients; however, careful consideration of potential adverse outcomes is necessary.

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“…While coordination with structured weight loss programs or even bariatric surgery is not standard at our center, these strategies may improve the success of this approach. 23,24…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

Zaliznyak

Stern²,

Cole³

et al. 2021

ASAIO Journal

View full text Add to dashboard Cite

show abstract

“…In fact, several studies show that obesity is a risk factor for morbidity and mortality in heart disease and almost doubles the risk of developing HF [29]. Obesity not only leads to the increase in incidence of HF but evidence suggests that there is also a dose-effect of BMI and rates of hospitalization for HF exacerbations [21,[30][31][32][33][34].…”

Section: Obesity In Heart Failurementioning

confidence: 99%

“…1), further outlined below. In the heart failure population specifically, bariatric surgery often times can also serve as a bridge to transplant or LVAD in those heart failure patients who struggle with qualifying for these advanced therapies based on BMI [33,34].…”

Section: Bariatric Surgerymentioning

confidence: 99%

Weighing in on heart failure: the potential impact of bariatric surgery

et al. 2021

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Obesity is a growing worldwide epidemic with significant economic burden that carries with it impacts on every physiologic system including the cardiovascular system. Specifically, the risk of heart failure has been shown to increase dramatically in obese individuals. The purpose of this review is to provide background on the individual burdens of heart failure and obesity, followed by exploring proposed physiologic mechanisms that interconnect these conditions, and furthermore introduce treatment strategies for weight loss focusing on bariatric surgery. Review of the existing literature on patients with obesity and heart failure who have undergone bariatric surgery is presented, compared, and contrasted.

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“…Few small cohort studies and case reports have shown promising results of bariatric surgery (BS) in obese patients with VADs [3][4][5][6]. Nevertheless, much of the postoperative weight (and BMI) trends remains unknown in this population.…”

Section: Objectivementioning

confidence: 99%

Bariatric surgery in obese patients with ventricular assist devices

et al. 2020

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Objectives: Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight, which may prevent them from receiving heart transplantation (HT) if their body mass index (BMI) reaches ≥ 35 kg/m 2. The objective was to synthesize all cases available in the literature and describe the most important outcomes of bariatric surgery (BS) in VAD patients, including BMI trends, reaching a BMI < 35 kg/m 2 , listing for HT, achieving HT, myocardial recovery, and mortality. These data were obtained for an individual participant data (IPD) meta-analysis and include available IPD for every case in the scientific literature describing VAD patients undergoing BS during VAD support with documented postoperative BMI (and time of measurement) during follow-up. Data description: These data include baseline, periprocedural, and long-term outcomes for the 29 patients meeting selection criteria. The composite outcome includes reaching a BMI < 35 kg/m 2 , listing for HT, receiving HT, and myocardial recovery, indicating significant BMI loss associated with major ESHF outcomes. As multiple centers are becoming more experienced in this field, the present data can be merged with their databases to form larger samples that will allow to perform further statistical analysis to identify outcome predictors and improve clinical protocols and outcomes.

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Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation

Cited by 25 publications

References 17 publications

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work?

Weighing in on heart failure: the potential impact of bariatric surgery

Bariatric surgery in obese patients with ventricular assist devices

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