Bariatric Surgery In Advanced Heart Failure Patients As A Bridge To Advanced Therapies (b2b)

Introduction Obesity poses significant challenges in advanced heart failure patients who otherwise meet criteria for either left ventricular assist devices (LVAD) or heart transplant (HT). Current guidelines suggest body mass index (BMI) cutoff for HT of Methods A retrospective single center analysis of patients in the dedicated Obesity Clinic at University Hospitals were examined, identifying patients with left ventricular ejection fraction (LVEF) Results Between 2010 and 2019, there were 191 patients with history of obesity (BMI > 35kg/m2) and heart failure who were referred to the Obesity Clinic for bariatric surgery as demonstrated in Figure 1. Of this group, 58 (30%) of patients had heart failure with reduced ejection fraction, in which 22 (38%) went directly to bariatric surgery, 8 (14%) recovered their LVEF prior to gastric surgery, 19 (33%) were pending gastric surgery, and 9 (16%) developed advanced heart failure requiring implantation of an LVAD as B2B. Of the LVAD group, 5 patients underwent bariatric surgery and successfully met the goal of desired BMI for HT listing. All 5 patients were listed for HT, with 3 proceeding successfully to HT and 2 awaiting offers. Compared to morbidly obese patients who proceeded directly to gastric bypass surgery, those who underwent B2B had a lower BMI (51.67 ± 11.39 vs 41.9 ± 4.45 kg/m2; p = 0.00163), lower LVEF (32.16 ± 6.83 vs 18.06 ± 7.68%, p Conclusions B2B offers a successful pathway for obese patients to undergo HT.