Background

Patients with severe end-stage heart failure (ESHF) may require left ventricular assist device (LVAD) placement before definite heart transplant. To undergo heart transplant, patients need to have a BMI < 35 kg/m2. Bariatric surgery is an effective tool for weight loss in patients with obesity and ESHF before transplant. Revisional bariatric surgery for this specific subset of patients is not well elucidated.

Methods

A 38-year-old male with ESHF (ejection fraction <16%), a history of sleeve gastrectomy (SG) and a BMI of 46.3 kg/m2 presented for revisional bariatric surgery evaluation in order to reduce his BMI to less than 35 kg/m2 to be eligible for transplantation. We proceeded with a SG to single anastomosis duodeno-ileostomy (SADI-S) conversion. Preoperative workup including optimization of his anticoagulation was completed. His warfarin was stopped, and he was bridged to heparin until 6 hours prior to surgery. Intraoperatively, an LVAD alarm reflecting hypoperfusion was managed. No other intraoperative complications were noted.

Results

The patient was started on heparin drip and bridged to warfarin on postoperative day (POD) 1. He was discharged on POD 4 with an INR of 1.9. No complications were reported at 30-day follow-up and his BMI was 41 kg/m2.

Conclusions

Revisional bariatric surgery is a feasible option in patients with LVAD awaiting heart transplant.