Purpose Obesity is a relative contraindication for heart transplant due to its associated perioperative risks and mortality. The aim of this study is to investigate the role of sleeve gastrectomy on improving transplant candidacy in patients with advanced heart failure. Methods Retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent sleeve gastrectomy for durable weight loss in order to meet eligibility criteria for cardiac transplantation. Results 21 patients (17M/4F), age range 23-61 with advanced heart failure (left ventricular ejection fraction [LVEF] mean: 24%, standard deviation [SD]: 10.5%) underwent sleeve gastrectomy. Mean preoperative body mass index [BMI] was 42.1 kg/m2 (SD 16.2). There were no major perioperative complications in 18 of 21 patients. Mean length of stay (LOS) was 9 days and intensive care LOS of 1.7 days. At mean follow up of 4.3 years (SD 2.5 years), there have been no mortalities, mean BMI reduction was 9 (SD 4.3, p<0.005) and percentage total body weight loss was 23.4% (SD 9.6%, p<0.005). Postoperative LVEF improved by a mean of 15.7% (SD 11.3%, p<0.005) and 16 patients had an improvement in their New York Heart Association (NYHA) functional score by 1 or more (p<0.005). Five patients were listed for heart transplant, with four eventuating in heart transplant. Conclusion Bariatric sleeve gastrectomy can achieve enduring weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some cases, transplant can be avoided with significant improvements in LVEF and NYHA function.