{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:58:38Z","timestamp":1790618318837,"version":"4.1.0"},"reference-count":56,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Obesity is a common and potentially modifiable barrier to heart transplant candidacy in patients supported by a durable left ventricular assist device (LVAD). Approximately 15% of LVAD recipients carry a body mass index (BMI) of 35 kg\/m2 or greater; the 2024 International Society for Heart and Lung Transplantation guideline considers weight loss to a BMI below 35 kg\/m2 reasonable before listing, within an individualized assessment, and only 18.6% of these patients achieve a 10% weight reduction through supportive care alone. Two interventions can close this gap. Anti-obesity medications, principally glucagon-like peptide-1 receptor agonists (GLP-1 RAs), reduce BMI gradually without a procedural intervention; however, the largest LVAD series reports a BMI reduction from 38.3 to 36.2 kg\/m2 at one year with 26% of patients who began above 35 kg\/m2 falling below it, and efficacy depends on continued adherence and insurance coverage. In the FIGHT trial, liraglutide showed a non-significant, numerically unfavorable signal in recently hospitalized patients with advanced heart failure with reduced ejection fraction who were not on mechanical support. Metabolic bariatric surgery, most often laparoscopic sleeve gastrectomy, delivers a BMI reduction of 6 to 10 kg\/m2 within 6 to 12 months and was associated with a threefold higher probability of subsequent transplantation in an observational Medicare cohort, at the cost of serious 30-day complications in 11.3% of LVAD recipients compared with 2.5% of non-LVAD bariatric patients. This narrative review compares mechanisms, LVAD-specific liabilities, and published outcomes of both strategies, including cardiovascular and arrhythmic outcomes, and reframes the choice as a trade-off between the speed of BMI reduction and the distribution of risk over time. We propose a hypothesis-generating selection framework, based on expert opinion, that considers excess BMI above threshold, expected time on device, bleeding profile, and gastrointestinal tolerance, and we define the evidence gaps that a prospective study should address.<\/jats:p>","DOI":"10.3390\/jcm15197489","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anti-Obesity Medications Versus Metabolic Bariatric Surgery as Pathways to Heart Transplant Eligibility in LVAD-Supported Patients: A Narrative Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Noah","family":"Sicouri","sequence":"first","affiliation":[{"name":"Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA 15260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8149-7507","authenticated-orcid":false,"given":"Vanesa","family":"Brecher","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Androutsopoulou","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximiliano","family":"Brizzio","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prokopis-Andreas","family":"Zotos","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3754-6704","authenticated-orcid":false,"given":"Massimo","family":"Baudo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1822-768X","authenticated-orcid":false,"given":"Serge","family":"Sicouri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1056\/NEJMoa1602954","article-title":"Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure","volume":"376","author":"Rogers","year":"2017","journal-title":"N. 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