Bariatric surgery gave LVAD patient second chance at lifeJan. 13, 2022, 9:56 AM
by Matt Batcheldor
Six years ago, a doctor told Veronica Llamas-Barajas she had end-stage heart failure and six months to live. She needed a heart transplant, but her weight was too high to qualify. She was referred to Vanderbilt University Medical Center, believing the best she could hope for was to be kept comfortable for her remaining life. She was 36 years old.
“I didn’t feel like I had a future,” she said. “I didn’t want to die that young.”
In time, she found hope. She met with Sandip Zalawadiya, MBBS, medical director of the Ventricular Assist Device Program at Vanderbilt for further care. “High body mass index (BMI) takes away the opportunity of direct heart transplant from many end-stage heart failure patients. In such cases, we opt for left ventricular assist device (LVAD), an implantable, mechanical support system to pump blood through the body when the heart is too sick to do it.”
In 2018, Llamas-Barajas received an LVAD at Vanderbilt. Then, in August 2021, she became the first LVAD patient in Tennessee to undergo bariatric surgery. The hope was to reduce her weight to the point where she would meet the criteria to be placed on the waiting list for a heart transplant.
“Ever since I started with Vanderbilt, that’s when I felt my second chance,” she said.
Llamas-Barajas underwent a sleeve gastrectomy performed by Wayne English, MD, associate professor of Surgery and director of Clinical Research for the Vanderbilt Center for Surgical Weight Loss. During the procedure, the most common bariatric surgery performed in the United States, English removed about 80% of her stomach, leaving it roughly the size and shape of a banana.
The procedure removes the cells that produce a hormone responsible for hunger. As a result, patients will not feel hungry and eat less, English said.
Within a few weeks post-procedure, Barajas said she lost about 38 pounds because of the procedure and a liquid diet she started a week before. Three months following the procedure, she had lost about 70 pounds and now qualifies as a candidate for a heart transplant. She will be placed on the transplant candidate list after her weight loss has stabilized, English said.
“She did so remarkably well,” English said. “This is absolutely outstanding. Her body mass index now is significantly less, almost 12 full points, than what it was prior to surgery.”
Llamas-Barajas said she has much more energy than before the surgery and doesn’t get winded nearly as easily. Before, she would need to use the electric shopping cart to buy groceries; now she pushes a standard shopping cart.
“We went to Chicago for Thanksgiving … and we walked all downtown,” she said. “We even went to the zoo. I can walk a whole lot more than I used to. I would never think about going to the zoo. I haven’t been in a lot of years. It’s changed a whole, whole lot.”
Getting to the point of offering such a surgery took VUMC two years — both for the institution to develop protocols for the higher-risk LVAD patients, and to offer evaluations and counseling to ensure the first patient was right for the procedure. Zalawadiya began developing protocols for LVAD patients to receive weight loss surgery in 2019.
“Only a few hospitals around the world currently have the medical and surgical expertise to offer such a highly complex procedure in LVAD patients,” said Zalawadiya. “LVAD patients are on blood thinners and have a drive-line that comes out of their abdomen to connect to an external battery — the power source, both of which make the surgery challenging.
“However, we are committed to patients like Veronica and wanted to get this right from the very beginning. What we now have is this amazing partnership between us and Dr. English’s team, and our hope is that more patients in Veronica’s position benefit from that.”
Meanwhile, Llamas-Barajas, like all other weight loss surgery candidates, was required to participate in months of medical weight management and psychological counseling to ensure that she was a good candidate to keep the weight off after surgery.
Patients must make wholesale life changes, including managing an altered sense of hunger and dietary requirements after the surgery.
“I accepted this operation first and foremost for me and my family, but second, also for the people, the LVAD people after me, so that they can know that there is a chance,” Llamas-Barajas said. “Because, in my family, we have genetic heart failure. And I just want them to know that’s it’s not the end of the road.”
Llamas-Barajas is looking forward to the prospect of being added to the heart transplant list in the new year.
“It’s so exciting because I know that I’m one step closer” to transplant, she said. “It motivates me to do better, to make the correct choices.”
Several members of both the LVAD and bariatric surgery teams played a crucial role in Llamas-Barajas’ success, including but not limited to Jessica Hassler, RN (VAD coordinator), Casey West, ANP (VAD nurse practitioner), Robert Tunney, PharmD (VAD pharmacist), Wendy Tarpley, RN, BSN (Bariatric Program Coordinator, Vanderbilt Weight Loss) and Jan Lemanski, BSN, RN (Clinic Nurse, Vanderbilt Weight Loss).