Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices

We identified the patients with end-stage heart failure and ventricular assist devices (VADs) who underwent bariatric surgery at Ochsner Medical Center, the only center with a VAD program in the State of Louisiana, USA. Every patient underwent a comprehensive preoperative evaluation that included psychological, metabolic, nutritional, and cardiovascular assessments. All patients were over the age of 18 years and underwent laparoscopic sleeve gastrectomy (LSG) between 2016 and January 2020. All patients were on chronic antiplatelet and anticoagulation therapy with warfarin and aspirin. Both medications were held at the time of admission and heparin infusion was started until the midnight prior to LSG. If the INR was > 1.5 the evening prior to the surgery, the patient received fresh frozen plasma and then, the INR was remeasured in the morning prior to surgery, which was performed when the INR was ≤ 1.5. Provided that the patient developed no bleeding complication, heparin was started at 200 U/hr eight hours after LSG, increased to 400 U/hr during the postoperative day one. The following day, heparin was titrated to a goal thromboplastin time of 35-45 sec with addition of aspirin. On postoperative day three, the goal thromboplastin time was increased to 45-54 sec and warfarin was restarted at a dose of 1 mg. This dataset (database: LSG in patients with VADs) includes baseline, periprocedural, and outcome data, which are described in one of the attached documents (description of variables).本研究纳入美国路易斯安那州唯一开设心室辅助装置（ventricular assist devices, VADs）项目的奥克斯纳医疗中心中，接受减重手术的终末期心力衰竭合并心室辅助装置置入患者。所有患者均接受了涵盖心理、代谢、营养及心血管评估的全面术前评估，且年满18周岁，于2016年至2020年1月期间接受腹腔镜袖状胃切除术（laparoscopic sleeve gastrectomy, LSG）。所有患者均长期接受华法林与阿司匹林联合的抗血小板及抗凝治疗。入院时需暂停上述两种药物，并于腹腔镜袖状胃切除术术前午夜前启动肝素输注。若术前一晚的国际标准化比值（international normalized ratio, INR）＞1.5，则为患者输注新鲜冰冻血浆，随后于术前晨起复测INR，仅当INR≤1.5时方可实施手术。若患者未出现出血并发症，则于腹腔镜袖状胃切除术后8小时以200 U/hr的速率启动肝素输注，术后首日将剂量增至400 U/hr。术后次日，根据目标凝血活酶时间35~45秒调整肝素剂量，并加用阿司匹林。术后第3日，将目标凝血活酶时间上调至45~54秒，并以1 mg的起始剂量重新启用华法林。本数据集（数据库命名：VAD置入患者的腹腔镜袖状胃切除术）包含基线数据、围手术期数据及结局数据，相关变量说明详见所附文档之一。