Background
Class II obesity affects 1 in 5 patients with left ventricular assist device (LVAD)
and is considered a potential barrier to heart transplantation (HT). Studies about
the outcomes of bariatric surgery in this population are scarce.
Methods
We identified Medicare beneficiaries who had an LVAD placed from 2012 to 2019 and
had at least class II obesity at the time of LVAD placement and identified patients
who underwent bariatric surgery during or after the LVAD implantation admission. The
primary outcome was major adverse cardiovascular events (MACE) at 30 days (mortality,
cerebral hemorrhage, or ischemic stroke) after bariatric surgery.
Results
Among patients who underwent LVAD implantation from 2012 to 2019, 2798 (19.4%) had
at least class II obesity, and 198 (7.1%) patients had bariatric surgery (24 on same
admission and 174 after a median of 702 days). After bariatric surgery in LVAD patients,
30-day MACE was 6.1%, 30-day mortality was <5.5%, and 1-year mortality was 12.6%.
Heart failure readmission burden declined after bariatric surgery (incidence rate
ratio 0.20 (95% CI 0.11-0.38), p < 0.001). Thirty-seven patients underwent HT after a median of 371 days (IQR 246-575
days), and 13 patients underwent LVAD explant due to recovery. On time-dependent,
competing risk, Cox regression, bariatric surgery was associated with a 3-fold higher
probability of HT in follow-up compared to patients who did not get bariatric surgery
(sub-distribution HR 2.95, 95% CI 2.09-4.17, p < 0.001).
Conclusions
Bariatric surgery in patients with LVAD support is associated with decreased heart
failure events and higher chances of heart transplantation.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Impact of obesity on ventricular assist device outcomes.J Card Fail. 2020; 26: 287-297
- The impact of obesity on patients bridged to transplantation with continuous-flow left ventricular assist devices.JACC: Heart Fail. 2016; 4: 761-768
- The 2016 international society for heart lung transplantation listing criteria for heart transplantation: a 10-year update.J Heart Lung Transplant. 2016; 35: 1-23
- Ventricular assist device implantation and bariatric surgery: a route to transplantation in morbidly obese patients with end-stage heart failure.ASAIO J. 2021; 67: 163-168
- Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation.Surg Obes Relat Dis. 2019; 15: 1780-1784
- Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant.Surg Obes Relat Dis. 2018; 14: 1269-1273
- Bariatric surgery in end-stage heart failure: feasibility in successful attainment of a target body mass index.J Card Fail. 2020; 26: 944-947
- Bariatric surgery complications before vs after implementation of a national policy restricting coverage to centers of excellence.JAMA. 2013; 309: 792-799
- Assessment of obesity prevalence and validity of obesity diagnoses coded in claims data for selected surgical populations: A retrospective, observational study.Medicine (Baltimore). 2019; 98: e16438
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- Validity of race and ethnicity codes in medicare administrative data compared with cold-standard self-reported race collected during routine home health care visits.Med Care. 2020; 58: e1-e8
- A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509
- Time-dependent covariates in the Cox proportional-hazards regression model.Annu Rev Public Health. 1999; 20: 145-157
- Role of weight bias and patient-physician communication in the underutilization of bariatric surgery.Surg Obes Relat Dis. 2021; 17: 1926-1932
- Sleeve gastrectomy in patients with continuous-flow left ventricular assist devices: a systematic review and meta-analysis.Obes Surg. 2020; 30: 4437-4445
- Bariatric surgery in patients with severe heart failure.Obes Surg. 2020; 30: 2863-2869
- Bariatric surgery and cardiovascular outcomes in patients with obesity and cardiovascular disease: a population-based retrospective cohort study.Circulation. 2021; 143: 1468-1480
- Reversibility of cardiac abnormalities in morbidly obese adolescents.J Am Coll Cardiol. 2008; 51: 1342-1348
- Effects of bariatric surgery on cardiovascular function.Circulation. 2008; 118: 2091-2102
- Favorable changes in cardiac geometry and function following gastric bypass surgery: 2-year follow-up in the Utah obesity study.J Am Coll Cardiol. 2011; 57: 732-739
- Effect of weight loss on predicted cardiovascular risk: change in cardiac risk after bariatric surgery.Obesity (Silver Spring). 2007; 15: 772-784
- Cardiovascular risk reduction following metabolic and bariatric surgery.Surg Clin North Am. 2021; 101: 269-294
- Gastric bypass reduces biochemical cardiac risk factors.Surg Obes Relat Di. 2007; 3: 8-13
- Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction.Circulation. 2017; 136: 6-19
- Trends, perioperative adverse events, and survival of patients with left ventricular assist devices undergoing noncardiac surgery.JAMA Netw Open. 2020; 3e2025118
Article info
Publication history
Published online: April 09, 2022
Identification
Copyright
© 2022 International Society for Heart and Lung Transplantation. All rights reserved.
