Continuous-Flow Left Ventricular Assist Devices and Bariatric Surgery in Patients with Morbid Obesity and Heart Failure - A Systematic Review
A body mass index (BMI) > 35 kg/m2 is a contraindication to transplantation in patients with end-stage heart failure. In these patients, bariatric surgery can be considered either concomitantly with continuous-flow left ventricular assist device (CF-LVAD) placement, or staged after CF-LVAD has be...
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| Published in: | The Journal of heart and lung transplantation Vol. 38; no. 4; pp. S80 - S81 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier Inc
01-04-2019
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| Online Access: | Get full text |
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| Summary: | A body mass index (BMI) > 35 kg/m2 is a contraindication to transplantation in patients with end-stage heart failure. In these patients, bariatric surgery can be considered either concomitantly with continuous-flow left ventricular assist device (CF-LVAD) placement, or staged after CF-LVAD has been placed. We sought to evaluate the outcomes for these approaches.
An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight original studies were pooled for systematic review and meta-analysis.
Of 53 patients, 24 (45%) underwent simultaneous bariatric surgery with CF-LVAD placement while 29 (55%) underwent staged bariatric surgery after CF-LVAD. The average age of all patients was 43.6 years (95% CI: 36.9-50.2) with 40% female. Laparoscopic sleeve gastrectomy was performed in 89% (95% CI: 74-96); gastric banding was performed in the remaining 11% (95% CI: 4-26). Average time between CF-LVAD implantation and bariatric surgery was 30.0 months (95% CI: 15.4-44.6) for staged procedures. Mean BMI at recent follow-up (34.2 kg/m2, 95% CI: 31.4-36.9) was significantly lower than mean preoperative BMI (45.9 kg/m2, 95% CI: 43.2-48.7) (p=0.01). There was no significant difference in incidence of postoperative complications [simultaneous, 17% (95% CI, 2-65) vs staged, 20% (95% CI, 6-51), p=0.89] or overall survival [simultaneous, 92% (95% CI, 72-98) vs staged, 81% (95% CI, 62-92), p=0.29] for average follow-up time of 10.6 months (Table). Surgery resulted in 67% of patients (95% CI: 52-79) being listed for heart transplantation, including 31% (95% CI: 19-46) who were transplanted.
Both simultaneous and staged approaches have comparable outcomes, which can allow previously ineligible patients to undergo heart transplantation. Increased complication rate in both groups likely reflects the complexity of the patients and not the timing of the procedure. |
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| ISSN: | 1053-2498 1557-3117 |
| DOI: | 10.1016/j.healun.2019.01.185 |