PMID- 17903770
OWN - NLM
STAT- MEDLINE
DCOM- 20080108
LR  - 20211020
IS  - 1550-7289 (Print)
IS  - 1550-7289 (Linking)
VI  - 3
IP  - 5
DP  - 2007 Sep-Oct
TI  - Bariatric surgery improves cardiac function in morbidly obese patients with 
      severe cardiomyopathy.
PG  - 503-7
AB  - BACKGROUND: Longstanding morbid obesity can be associated with severe 
      cardiomyopathy. However, the safety and efficacy of bariatric surgery in patients 
      with severe cardiomyopathy has not been studied, and the effect of surgical 
      weight loss on postoperative cardiac function is also unknown. In addition, 
      morbidly obese patients have significantly increased mortality associated with 
      cardiac transplantation, often precluding them from becoming recipients. METHODS: 
      A retrospective study of patients with a left ventricular ejection fraction < or 
      =35% who underwent bariatric surgery (1998-2005) was performed. Short-term 
      morbidity/mortality, length of stay, excess weight loss, pre- and postoperative 
      left ventricular ejection fraction, and New York Heart Association (NYHA) 
      functional class were assessed. RESULTS: A total of 14 patients (10 men and 4 
      women) with a mean preoperative body mass index of 50.8 +/- 2.04 kg/m(2) 
      underwent bariatric surgery (10 underwent laparoscopic Roux-en-Y gastric bypass, 
      1 open Roux-en-Y gastric bypass, 2 sleeve gastrectomy, and 1 laparoscopic gastric 
      banding). The complications were pulmonary edema in 1, hypotension in 1, and 
      transient renal insufficiency in 2. The median length of stay was 3.0 days (range 
      2-9). The mean excess weight loss at 6 months was 50.4%, with a decrease in the 
      mean body mass index from 50.8 +/- 2.04 kg/m(2) to 36.8 +/- 1.72 kg/m(2). The 
      mean left ventricular ejection fraction at 6 months had significantly improved 
      from 23% +/- 2% to 32% +/- 4% (P = .04), correlating with improved functional 
      capacity, as measured by the NYHA classification. Preoperatively, 2 patients 
      (14%) had an NYHA classification of IV, 6 (43%) a classification of III, and 6 
      (43%) a classification of II. At 6 months postoperatively, no patient had an NYHA 
      classification of IV, 2 (14%) had a classification of III, and 12 (86%) an NYHA 
      classification of II. Two patients had undergone cardiac transplant evaluations 
      preoperatively and underwent successful transplantation after weight loss. 
      CONCLUSION: The results of our study have shown that bariatric surgery for 
      patients with cardiomyopathy is feasible and effective. Surgically induced weight 
      loss results in both subjective and objective improvement in cardiac function. In 
      addition, surgical weight loss can provide a bridge to transplantation in 
      patients who were prohibited secondary to their morbid obesity.
FAU - McCloskey, C A
AU  - McCloskey CA
AD  - Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, 
      Pennsylvania 15227, USA. mccloskeyc@upmc.edu
FAU - Ramani, G V
AU  - Ramani GV
FAU - Mathier, M A
AU  - Mathier MA
FAU - Schauer, P R
AU  - Schauer PR
FAU - Eid, G M
AU  - Eid GM
FAU - Mattar, S G
AU  - Mattar SG
FAU - Courcoulas, A P
AU  - Courcoulas AP
FAU - Ramanathan, R
AU  - Ramanathan R
LA  - eng
GR  - UL1 TR000005/TR/NCATS NIH HHS/United States
PT  - Journal Article
PL  - United States
TA  - Surg Obes Relat Dis
JT  - Surgery for obesity and related diseases : official journal of the American 
      Society for Bariatric Surgery
JID - 101233161
SB  - IM
MH  - Adult
MH  - Anastomosis, Roux-en-Y
MH  - *Bariatric Surgery/adverse effects
MH  - Body Mass Index
MH  - Cardiomyopathies/*complications/*physiopathology
MH  - Female
MH  - Gastric Bypass
MH  - Heart/*physiopathology
MH  - Humans
MH  - Hypotension/etiology
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Obesity, Morbid/*complications/physiopathology/*surgery
MH  - Pulmonary Edema/etiology
MH  - Renal Insufficiency/etiology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Weight Loss
EDAT- 2007/10/02 09:00
MHDA- 2008/01/09 09:00
CRDT- 2007/10/02 09:00
PHST- 2006/05/27 00:00 [received]
PHST- 2007/05/23 00:00 [revised]
PHST- 2007/05/26 00:00 [accepted]
PHST- 2007/10/02 09:00 [pubmed]
PHST- 2008/01/09 09:00 [medline]
PHST- 2007/10/02 09:00 [entrez]
AID - S1550-7289(07)00497-2 [pii]
AID - 10.1016/j.soard.2007.05.006 [doi]
PST - ppublish
SO  - Surg Obes Relat Dis. 2007 Sep-Oct;3(5):503-7. doi: 10.1016/j.soard.2007.05.006.