Regression of severe heart failure after combined left ventricular assist device placement and sleeve gastrectomy

Abstract

Patients who suffer morbid obesity and heart failure (HF) present unique challenges. Two cases are described where concomitant use of laparoscopic sleeve gastrectomy (LSG) and left ventricular assist device (LVAD) placement enabled myocardial recovery and weight loss resulting in explantation. A 29-year-old male patient with a body mass index (BMI) of 59 kg/m 2 and severe HF with a left ventricular ejection fraction (LVEF) of 20-25% underwent concomitant LSG and LVAD placement. Sixteen months after surgery, his BMI was reduced to 34 kg/m 2 and his LVEF improved to 50-55%. A second 41-year-old male patient with a BMI of 44.8 kg/m 2 with severe HF underwent the same procedures. Twenty-four months later, his BMI was 31.1 kg/m 2 and his LVEF was 50-55%. In both cases, the LVAD was successfully explanted and patients remain asymptomatic. HF teams should consult and collaborate with bariatric experts to determine if LSG may improve the outcomes of their HF patients.

Failure to rescue: obesity increases the risk of mortality following early graft failure in heart transplantation in UNOS database patients

“…Punchai et al [ 16 ] described their experience with laparoscopic sleeve gastrectomy on obese ventricular assist device patients and found a reduction in New York Heart Association class from preoperative class 3 to preoperative class 2. In a case report of 2 patients with a BMI of >40 kg/m 2 and severe heart failure requiring left ventricular assist device (LVAD) implantation, Nathan et al [ 17 ] described improvement in left ventricular ejection fraction to normal values and a significant decrease in BMI over 2 years. In both patients, the LVAD was explanted and heart transplantation was not necessary.…”

Intraoperative Management for Left Ventricular Assist Device Implantation With Concurrent Laparoscopic Sleeve Gastrectomy: A Case Series

“…The LVAD was implanted first as previously described. 3,4 Of note, 9 LVAD implantations were done without CPB support (Table 2). TEE was utilized to adjust the LVAD pump flow, dictate transfusion of volume, and titrate vasoactive support at the discretion of the anesthesiologist based on pulsatility and interventricular septum positioning.…”