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Laparoscopic Sleeve Gastrectomy in a Patient with Severe Ischemic Heart Failure Requiring a Left Ventricular Assist Device as a Bridge to Cardiac Transplantation

Jeffrey Friedman

 Background: Obesity is associated with heart failure due to structural and functional changes within the heart. Obesity increases metabolic demand, total blood volume, and stroke volume. This causes left ventricular dilatation, cardiac hypertrophy, and atrial enlargement. Definitive treatment for severe heart failure is cardiac transplantation. Transplantation is not an option for patients with a BMI over 35 kg/m2. We describe our method of laparoscopic sleeve gastrectomy in patients with heart failure requiring a left ventricular assist device as a means for weight loss in order to bridge the patient to cardiac transplantation. Results: Post-operatively the patient recovered in the heart failure unit, was immediately started on the bariatric protocol, a heparin drip restarted 6 hours post-operatively, and was discharged home when his INR was therapeutic without complication Conclusion: Sleeve gastrectomy can be safely utilized in patients with end-stage heart failure and morbid obesity in order to achieve weight loss to become eligible for transplant listing.