Bariatric surgery in patients with obesity and end-stage heart failure with left ventricular assist devices: a brief guide

The prevalence of obesity is increasing worldwide, leading to a rise in several comorbidities, and is itself an important risk factor for heart failure. Patients with end-stage heart failure and obesity are often not eligible for heart transplantation (HT) and instead receive cardiac support from left ventricular assist devices (LVAD). In the absence of other contraindications, patients with obesity who are on LVAD support can lose enough weight to later qualify for HT. Bariatric surgery had been explored as an approach for weight loss in this patient population and was found to be a safe and effective option. One recent systematic review and meta-analysis has shown 67.4% of patients with LVAD support are able to be listed for transplantation after bariatric surgery and subsequent weight loss (95%CI: 0.477-0.871). Of these, 32.5% would go on to receive a heart transplant (95%CI: 0.201-0.448). There were also numerous cases of patients whose cardiac function improved after bariatric surgery such that they were delisted for HT and some had subsequent removal of their LVAD. There are many perioperative considerations when evaluating patients with LVADs for bariatric surgery. However, with careful patient selection by a multidisciplinary team and mindful preparation, patients with obesity and end-stage heart failure have an opportunity for longer years of life.