Clinical Scorecard: Comparative Analysis of Simultaneous and Interval Sleeve Gastrectomy in Patients with End-stage Heart Failure Dependent on Left Ventricular Assist Devices: A Retrospective Study from a Single Institution

At a Glance

Key Highlights

• Simultaneous LVAD implantation and LSG performed in 54 patients; interval LSG in 23 patients.

• Primary endpoint: sleeve-related complications within 90 days were lower in simultaneous group (7.4%) vs. interval group (17.4%).

• Median BMI at baseline was 44.7 kg/m².

• Most participants were male with significant systemic disease (ASA classification III or higher).

• Non-ischemic cardiomyopathy was the cause of heart failure in 82% of patients.

Guideline-Based Recommendations

Diagnosis

• Patients should be assessed for eligibility for LVAD and bariatric surgery based on BMI and comorbidities.

Management

• Consider simultaneous LVAD implantation and LSG to reduce cumulative surgical risks.

Monitoring & Follow-up

• Monitor for sleeve-related complications within 90 days post-surgery.

Risks

• Be aware of device-specific risks such as driveline infections and pump thrombosis.

Patient & Prescribing Data

Adults with ESHF and obesity (BMI ≥35 kg/m²)

Simultaneous procedures may reduce overall healthcare utilization and improve transplant candidacy.

Clinical Best Practices

• Conduct thorough preoperative assessments for cardiac and bariatric surgical suitability.

• Manage perioperative anticoagulation carefully to mitigate bleeding and thrombotic complications.

Related Resources & Content

1. International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024, ScienceDirect

2. 2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure, JACC

3. Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis, PubMed

4. Obesity Surgery — Effects of Sleeve Gastrectomy on Weight Reduction and Cardiac Function in Obese Patients with Type 2 Diabetes Mellitus

5. Obesity Surgery — Comparative Effects of Sleeve Gastrectomy and Single Anastomosis Sleeve Ileal Bypass on Cardiac Function and Rhythm Abnormalities

6. Obesity Surgery — Decreased Hospitalization Requirements Following Sleeve Gastrectomy: An Observational Study from a Single Institution

7. Obesity Surgery — Decreases in Epicardial Fat and Mediastinal Adipose Tissue Correlate with Enhanced Cardiac Function

8. Bariatric surgery and left ventricular assist device in patients with heart failure: A systematic review and meta-analysis.

9. Obesity, Challenges, and Weight-Loss Strategies for Patients With Ventricular Assist Devices | JACC: Heart Failure

10. International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates—2024 - ScienceDirect

11. The ABC of Heart Transplantation—Part 1: Indication, Eligibility, Donor Selection, and Surgical Technique - PMC

12. 2025 ACC Scientific Statement on the Management of Obesity in Adults With Heart Failure: A Report of the American College of Cardiology | JACC

13. Sleeve Gastrectomy in Patients with Continuous-Flow Left Ventricular Assist Devices: a Systematic Review and Meta-Analysis - PubMed

14. Oral 234 Simultaneous versus interval sleeve gas