Successful Robotic Sleeve Gastrectomy in a Patient with Left Ventricular Assist Device

Abstract

<h3>Introduction</h3> Severe obesity is an absolute contra-indication to heart transplantation in patients with end stage heart failure. Left Ventricular Assist Devices (LVAD) can be used as a bridge to transplant, recovery or destination therapy. There is limited data in the literature evaluating sleeve gastrectomy in severely obese patients with LVADs. We present a patient who underwent successful bariatric surgery while on LVAD support. <h3>Case Report</h3> We present a 28-year-old female with history of class III Obesity (Body Mass Index of 55 kg/m²⁾, Heart Failure with reduced Ejection Fraction secondary to Postpartum Cardiomyopathy, who underwent HeartMate 3 left ventricular assist device implantation as destination therapy with the goal of bariatric surgery for weight loss and eventual bridge to transplant. Of note Patient post LVAD course was complicated by chronic re-current drive line infections, sternal wound infection, menorrhea, spontaneous subdural hematoma. Two years post LVAD patient was at a BMI of 44 kg/m². A multidisciplinary team was formed to formulate protocols and algorithms for Pre-Op, intra-Op and post Op care for LVAD patients undergoing bariatric surgery. The team was composed of Advanced Heart Failure, Bariatric and Cardio-thoracic surgery transplant ID, and Anesthesia. Guided by our multidisciplinary protocols, patient subsequently underwent successful robotic sleeve gastrectomy without any complications. <h3>Summary</h3> LVAD and robotic sleeve gastrectomy are both technically reasonable options for Advanced Heart Failure patients with severe obesity. LVAD permits cardiac support as bariatric surgery assists in efficacious weight loss. Together, they are a safe and effective treatment option that can bridge Advanced Heart Failure patients to heart Transplant candidacy. Decision to pursue LVAD and sleeve gastrectomy should incorporate a multidisciplinary team approach. Given the high prevalence of Obesity, this joint therapy has the potential to bridge many heart failure patients to transplant.