Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis

Purpose A body mass index (BMI) > 35 kg/m(2)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/m(2), 95% CI: 30.2-36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m(2), 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.