Journal article
Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis
Obesity surgery, v 30(11), pp 4437-4445
01 Nov 2020
PMID: 32654017
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose
A body mass index (BMI) > 35 kg/m2 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/m2, 95% CI: 30.2–36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m2, 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.
Metrics
Details
- Title
- Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis
- Creators
- Jothika Challapalli - Drexel UniversityElizabeth J Maynes - Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USAThomas J O'Malley - Thomas Jefferson UniversityDevon E Cross - Thomas Jefferson UniversityMatthew P Weber - Thomas Jefferson UniversityJae Hwan Choi - Thomas Jefferson UniversityRajesh Aggarwal - Thomas Jefferson UniversityAndrew J Boyle - Thomas Jefferson UniversityDavid J Whellan - Thomas Jefferson University HospitalJohn W Entwistle - Thomas Jefferson UniversityH Todd Massey - Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USARohinton J Morris - Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USAVakhtang Tchantchaleishvili - Thomas Jefferson University
- Publication Details
- Obesity surgery, v 30(11), pp 4437-4445
- Publisher
- Springer Nature
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000547357900001
- Scopus ID
- 2-s2.0-85087805658
- Other Identifier
- 991021881612004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery