Background

In additional to reducing obesity-related cardiovascular disease risk factors, bariatric surgery has been recognized as a method for improving cardiac function in patients with underlying heart disease. We present a case of laparoscopic sleeve gastrectomy (LSG) performed as a bridge to heart transplantation in a patient with obesity, heart failure, refractory recurrent left ventricular tachycardia, and a history of aortic valve replacement requiring anticoagulation.

Methods

To safely proceed with heart transplantation, a 64-year-old male with a body mass index of 39 kg/m2 and a complex cardiovascular history was referred to our bariatric surgery practice for evaluation. After failed medical therapy, elective LSG was scheduled. Due to rapid escalation of underlying cardiac disease, the patient was admitted to the cardiac intensive care and medically optimized prior to bariatric surgery. A multidisciplinary team approach was employed which included preoperative placement of an intra-aortic balloon pump (IABP) and heparinization the day before surgery.

Results

Following abridged medical optimization and IABP placement, LSG was expeditiously performed under meticulous anesthesia care and the patient was followed by multidisciplinary teams in the postoperative period. The patient tolerated the procedure without complication. Therapeutic anticoagulation was resumed on the first postoperative day and continued at discharge. The patient was then eligible for transplant.

Conclusions

Although considered a contraindication to weight loss surgery, severe cardiovascular disease may necessitate bariatric surgery as a bridge to curative cardiac therapy. IABP and multidisciplinary support can help facilitate LSG in medically complex patients with obesity awaiting transplant.