Left ventricular assist devices triple the risk of serious complications and longer hospital stay following bariatric surgery: a national analysis of 180,544 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program cases

Background: The growing population of left ventricular assist device (LVAD) patients faces increasing obesity-related comorbidities, which can adversely impact heart transplant candidacy. As these patients live longer, metabolic and bariatric surgery may become necessary, yet safety outcomes remain underexplored. Objective: This study evaluates safety and outcomes of primary bariatric procedures in LVAD patients using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Setting: MBSAQIP participating centers across the United States. Methods: Using the 2023 MBSAQIP database, we analyzed primary laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures. Patients were stratified by LVAD status. Primary outcomes were 30-day serious complications; secondary outcomes included length of stay, operative time, and postoperative complications. Results: Of 180,544 patients undergoing bariatric procedures, 133 (.07%) had LVADs. LVAD patients were older (49.5 versus 43.0 years, P < .001), female (60.1% versus 39.8%, P < .0001), and had higher rates of hypertension (79.7% versus 43.6%, P < .001), diabetes (51.8% versus 23.6%, P < .001), and therapeutic anticoagulation (45.9% versus 3.0%, P < .001). Most underwent SG (73.7%). LVAD patients had longer operative times (105.3 versus 84.6 min, P < .001), higher serious complications (11.3% versus 2.5%, P < .001), bleeding (5.3% versus .8%, P < .001), readmission (13.5% versus 2.9%, P < .001), and length of stay (4.9 vs 1.2 days, P < .001). After adjustment, LVAD and RYGB remained independently associated with serious complications (odds ratio [OR] 2.83, 95% confidence interval [CI] 1.62-4.97, P < .001 and OR 1.71; 95% CI 1.60-1.83; P < .001). Conclusion: Although LVAD patients face increased complications with bariatric surgery, this intervention remains essential for meeting transplant body mass index criteria. Careful patient selection and perioperative optimization are crucial, and further research is needed to improve outcomes in this high-risk population.