Abstract
Purpose Laparoscopic sleeve gastrectomy (LSG) has been associated with efficient and durable weight loss in obese patients with advanced heart failure (AHF) who undergo LVAD support. However, the effects of this combinatory approach on myocardial recovery remain undefined. Thus, we sought to evaluate the potential association between the combination therapy (LVAD support and LSG) and myocardial recovery in this patient cohort. Methods We retrospectively analyzed patients who underwent simultaneous LVAD implantation and LSG at our center from January 2013-August 2017. Demographic, biochemical, LVAD-related and transplant data were reviewed. Data from patients' outpatient follow-up appointments were gathered for 12 months. Echos were performed at baseline and 12 months. Myocardial recovery was defined as an improvement of LVEF ≥ 10%. Results 20 patients were included in this study. The average patient age was 47±13 years; 11 (56%) of the patients were male and the average BMI was 44±5 kg/m2. Ischemic heart disease was the underlying cause of heart failure in 7 (35%) of the patients. Three (15%) patients received a HeartWare device and 17 (85%) patients received a HeartMate II LVAD. The average pre-implant INTERMACS score was 2.7±0.6. Regarding the cardioprotective therapy, 9 (45%) of patients received ACEI/ARB, 11 (54%) beta blockers and 6 (27%) MRA. The average baseline LVEF was 21±5%; LVEF significantly improved to 32±14% at 12 months (p=0.001). Myocardial recovery was observed in 6 (30%) of the patients; two of these patients' LVEF improved to over 40% and had their LVAD explanted. Interestingly, the average HbA1c also significantly decreased at 12-month follow-up timepoint (6.6±1.5% vs. 5.1±0.5%, p=0.007). There were no deaths during the 12-month follow-up period. Conclusion The combined LVAD and LSG approach may represent a safe and feasible novel treatment strategy to promote myocardial recovery in obese patients with AHF. Although underlying mechanisms remain to be identified, a decrease in insulin resistance, as previously reported, achieved through a combined approach, may represent a significant contributing factor to myocardial recovery in this patient cohort.
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