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

Juan S Barajas-Gamboa; Valentin Mocanu; Mélissa V Wills; Gabriela Restrepo-Rodas; Pattharasai Kachornvitaya; Xinlei Zhu; Sol Lee; Thomas H Shin; Gustavo Romero-Velez; Matthew Allemang; Andrew T Strong; Ricard Corcelles; A Daniel Guerron; John Rodriguez; Matthew Kroh; Jerry T Dang; Salvador Navarrete

doi:10.1016/j.soard.2025.12.003

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

Surg Obes Relat Dis. 2025 Dec 31:S1550-7289(25)01087-1. doi: 10.1016/j.soard.2025.12.003. Online ahead of print.

Authors

Juan S Barajas-Gamboa¹, Valentin Mocanu², Mélissa V Wills², Gabriela Restrepo-Rodas³, Pattharasai Kachornvitaya², Xinlei Zhu², Sol Lee², Thomas H Shin⁴, Gustavo Romero-Velez⁵, Matthew Allemang⁵, Andrew T Strong⁵, Ricard Corcelles⁵, A Daniel Guerron¹, John Rodriguez⁶, Matthew Kroh⁵, Jerry T Dang⁵, Salvador Navarrete⁷

Affiliations

¹ Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
² Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
³ Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Khalifa University of Science and Technology, Biotechnology Center, College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.
⁴ Department of Surgery, University of Virginia, Charlottesville, Virginia.
⁵ Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
⁶ Digestive Diseases Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
⁷ Digestive Diseases & Surgery Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. Electronic address: NAVARRS@ccf.org.

PMID: 41577594
DOI: 10.1016/j.soard.2025.12.003

Abstract

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.

Keywords: Bariatric surgery; Complications; Gastric bypass; Heart failure; Left ventricular assist device; Sleeve gastrectomy; Transplant.