Simultaneous Versus Interval Sleeve Gastrectomy on Patients Requiring Left Ventricular Assist Devices for End-stage Heart Failure: A Retrospective, Single-Center Cohort Study

Durable Left ventricular assist devices (LVADs) are commonly employed as therapy in end-stage heart failure (ESHF). However, individuals with class II obesity (Body Mass Index (BMI) > 35 kg/m²) are often ineligible for heart transplant and have limited options. Laparoscopic sleeve gastrectomy (LSG) is increasingly utilized to facilitate weight loss and improve transplant candidacy. This study evaluates the safety of performing LSG in patients undergoing LVAD implantation who are otherwise ineligible for heart transplantation due to morbid obesity. A retrospective, single-center cohort study was conducted on congestive heart failure (CHF) patients who underwent either simultaneous LVAD and LSG or staged LSG following LVAD placement. The primary outcome was LSG-related complications within 90 days, including gastrointestinal (GI) bleeding, staple line leaks, and mortality. Secondary outcomes included reoperation rates, acute kidney injury (AKI), transfusion requirements, length of stay (LOS), readmissions, transplant rates, and percent excess body weight loss (%EBWL) at follow-up. Among 77 patients (54 simultaneous, 23 interval), LSG-related complications were lower in the simultaneous group (7.4% vs. 17.4%; p = 0.23). Transfusion rates were significantly lower in this group (38.9% vs. 69.6%; p = 0.02), though AKI was more frequent (72.2% vs. 56.6%; p = 0.19). One mortality occurred in the simultaneous cohort. No significant differences were observed in reoperations, LOS, readmissions, transplant rates, or %EBWL. Simultaneous LVAD/LSG was associated with comparable sleeve-related complication rates relative to interval LSG. Although limited by small sample size and potential temporal confounding, these findings hypothesize that simultaneous LVAD/LSG may potentially be a feasible strategy in select patients with obesity and ESHF. Larger prospective studies are needed to better define safety, patient selection, and long-term outcomes. Simultaneous LVAD and LSG did not increase complications. Simultaneous LVAD and LSG is a viable option for obese heart failure patients. Simultaneous LVAD and LSG may improve transplant candidacy.