PURPOSE: A body mass index (BMI) > 35 kg/m2 is a relative contraindication to heart transplantation in patients with end-stage heart failure. 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 of these approaches. MATERIALS AND METHODS: An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight studies were pooled for systematic review and metaanalysis. RESULTS: Overall, of 59 patients, 22 (37%) underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while 37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age of patients was 46 years (95% CI: 39-53) with 40% females. Mean BMI at most recent follow-up (33.4 kg/m2, 95% CI: 30.2-36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m2, 95% CI: 42.9-50.6) (p < 0.01). There was no significant difference in total incidence of postoperative complications (simultaneous, 16% (95% CI: 1-87%) versus staged, 23% (95% CI: 7-53%)) or in overall survival (simultaneous, 93% (95% CI: 72-99%) versus staged, 79% (95% CI: 60-90%), p = 0.17) for average follow-up time of 12.7 months. Bariatric surgery resulted in 66% of patients (95% CI: 51-79) to be listed for heart transplantation, including 33% (95% CI: 22-47) who were transplanted. CONCLUSIONS: Both simultaneous and staged bariatric surgeries with CF-LVAD placement have comparable outcomes and significantly reduce BMI. This can allow previously ineligible patients to undergo heart transplantation.
PURPOSE: A body mass index (BMI) > 35 kg/m2 is a relative contraindication to heart transplantation in patients with end-stage heart failure. 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 of these approaches. MATERIALS AND METHODS: An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight studies were pooled for systematic review and metaanalysis. RESULTS: Overall, of 59 patients, 22 (37%) underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while 37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age of patients was 46 years (95% CI: 39-53) with 40% females. Mean BMI at most recent follow-up (33.4 kg/m2, 95% CI: 30.2-36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m2, 95% CI: 42.9-50.6) (p < 0.01). There was no significant difference in total incidence of postoperative complications (simultaneous, 16% (95% CI: 1-87%) versus staged, 23% (95% CI: 7-53%)) or in overall survival (simultaneous, 93% (95% CI: 72-99%) versus staged, 79% (95% CI: 60-90%), p = 0.17) for average follow-up time of 12.7 months. Bariatric surgery resulted in 66% of patients (95% CI: 51-79) to be listed for heart transplantation, including 33% (95% CI: 22-47) who were transplanted. CONCLUSIONS: Both simultaneous and staged bariatric surgeries with CF-LVAD placement have comparable outcomes and significantly reduce BMI. This can allow previously ineligible patients to undergo heart transplantation.
Entities:
Keywords:
Bariatric surgery; Bridge to transplantation; Left ventricular assist device
Authors: Mandeep R Mehra; Charles E Canter; Margaret M Hannan; Marc J Semigran; Patricia A Uber; David A Baran; Lara Danziger-Isakov; James K Kirklin; Richard Kirk; Sudhir S Kushwaha; Lars H Lund; Luciano Potena; Heather J Ross; David O Taylor; Erik A M Verschuuren; Andreas Zuckermann Journal: J Heart Lung Transplant Date: 2016-01 Impact factor: 10.247
Authors: G L Winters; T J Kendall; S J Radio; J E Wilson; M R Costanzo-Nordin; B L Switzer; J A Remmenga; B M McManus Journal: J Heart Transplant Date: 1990 Jul-Aug