August 12, 2020
Obese patients with heart failure are more likely to meet eligibility criteria for a heart transplant if they first undergo bariatric surgery and receive a left ventricular assist device, according to a study conducted by Jefferson Health.
Obesity is known risk factor for heart failure; however, it is often also the reason many patients aren't considered eligible for a heart transplant. A higher body mass index makes the surgery more complicated and risky.
"Despite being at higher risk for heart disease, when patients with obesity develop heart failure, their road to transplant can be frustrating," said Dr. Vakhtang Tchantchaleishvili, a cardiac surgeon at Thomas Jefferson University Hospital.
Left ventricular assist device surgery is already considered a bridge to transplantation. The mechanical pump helps a failing heart pump blood to the rest of the body. Bariatric surgeries are designed to help patients lose weight.
Some doctors have tried combining LVAD with gastric bypass, a form of bariatric surgery, to improve their obese patients' chances of making it onto the heart transplant list.
The systematic review by Jefferson Health is the first study to assess whether this dual approach is generalizable to all obese patients in heart failure.
"The goal of the study was really to see if these two surgeries could improve a patient’s chance of eligibility for heart transplant, which is the best long-term treatment for heart failure," Tchantchaleishvili said.
The study, published last month in the journal Obesity Surgery, examined at two variations of the approach: having both surgeries at the same time or undergoing bariatric surgery first and then having an LVAD inserted about two years later.
The review included eight studies and 58 patients who underwent the dual surgery. Twenty-two of the patients had the surgeries simultaneously, 37 at differing times.
Within about a year of both surgeries being completed, 66% of the patients were able to meet the eligibility requirements for a heart transplant, including 33% who already had been received a transplant before the end of the study period.
The timing of the two surgeries didn't appear to make a difference.
"Many people don't realize that heart failure can be a multi-year disease," added co-author Dr. Todd Massey, the surgical director of Jeff's heart transplant program. "Our results show that we can improve a patient's chances of successfully being put on a transplant list by pairing these surgeries."
Patient selection criteria for a heart transplant includes advanced heart failure with symptoms that affect quality of life and lead to an overall poor prognosis without the transplant.
Smoking, cancer, older age and systematic diseases or infections also can prevent a patient from meeting eligibility criteria.