Duodenal Switch with heart failure

[Thunder Chicken 2]

I am 40 years old and have been diagnosed with chronic heart failure. My cardiologist recommended bariatric surgery because of my bmi and co morbid conditions. I have already met with the surgeon at the University of Utah where I get most of my medical care but my insurance will pay me $500 to have it done elsewhere. I have now been through the beginning portions of the weight loss program at a different hospital and have my "pre op" appointment on August 26th. I hadn't considered the duodenal switch because the university doesn't offer it but the new hospital does. After all of my research, I feel relatively confident that this is the most appropriate choice for me. However, I can't find much information on the best surgery for CHF patients(if there is a difference). Most people with CHF don't seem to be able to have surgery because of the risks, primarily of anesthesia. I have had 11 surgeries including 1 in October. I don't see this as being an issue for me and the cardiologist is the one who recommended the surgery. Has anyone dealt with this?

[froufrou 678]

I don't know any of the answers, but I hope that someone here can help you x

[Chiptress 327]

So sorry you’re going through this. I have no answers but I’ll keep you in my prayers. Is there a social worker or a patient advocate at either hospital that you can speak with? 🙏

[New&Improved 1,780]

You really need to speak with a surgeon or someone specialized in surgery to know if your heart could even handle such a surgery?

[RickM 1,747]

Likewise, I can't offer specifics for your condition, but this should be worked out between the surgeon and your cardioligist. Most of the surgeons who get into the DS these days are top notch, as it is a more complex procedure than most of the other WLS and it takes time and resources to develop, and maintain, those skills.

An option that may be suggested if your condition warrants it is to do the DS as a two step procedure, doing the VSG part of it first and then the intestinal switch part later after you have lost some of your weight and are stronger. This is sometimes done in cases where they don't want to put the patient through a lengthy anesthesia. The VSG can usually be done in about an hour or less, while the whole DS may typically take three hours or so, but occasionally 6-7 in complex cases, It doesn't seem to be done much as it was 10-15 years ago as the state of the art has improved over the years with reduced surgical times and better anesthesia care, but is still used in some cases.

[Thunder Chicken 2]

So the Dr who recommended surgery is a Heart transplant dr at the heart failure clinic. He didn’t specify which bariatric surgery, though.

[Chipwater 1]

You're in Utah...so am I. Best way to find the information you need is to check in with two groups that are the best at Duodenal Switch in Utah. Rocky Mountain Associated Physicians holds regular bariatric seminars at St. Marks Hospital. The one I went to was conducted by Dr. Rodrick McKinlay. I have other co-morbidity issues (not CHF). Much of the session is open question and answer with an actual bariatric surgeon.

The other group that seems to have some really good information is BMI Institute of Utah (Dr. Cottam). What I appreciate about this group is that they can send you a "self-pay" price list for Duodenal Switch.

The average cost of a DS in Utah is between $22K to $25K. BMI has a partial outpatient DS that runs around $16K (if you have health insurance that won't pay for bariatric surgery).

I was sad to learn that SelectHealth doesn't often cover these surgeries.

I would highly recommend that you talk to both Dr. McKinlay and Dr. Cottam to get some advice on how they would handle working with someone who has CHF.

All the best,

[Strivingforbetter 246]

@Thunder ChickenI agree with @Chipwater and his recommendations. I had my DS done with Dr. McKinlay in 2017, If your heart surgeon recommended the DS, I would have Dr. McKinaly consult with your doctor on the best weight loss surgery for you. He also does the sleeve and gastric bypass. I would have the utmost confidence that they would do what is right for you. We haven't heard back from you since August. Could you update us on where you're at in your research?