PMID- 32291707
OWN - NLM
STAT- MEDLINE
DCOM- 20210414
LR  - 20210414
IS  - 1708-0428 (Electronic)
IS  - 0960-8923 (Linking)
VI  - 30
IP  - 8
DP  - 2020 Aug
TI  - Bariatric Surgery in Patients with Severe Heart Failure.
PG  - 2863-2869
LID - 10.1007/s11695-020-04612-2 [doi]
AB  - PURPOSE: Obesity and cardiac failure are globally endemic and increasingly 
      intersecting. Bariatric surgery may improve cardiac function and act as a 
      bridge-to-transplantation. We aim to identify effects of bariatric surgery on 
      severe heart failure patients and ascertain its role regarding cardiac 
      transplantation. MATERIALS AND METHODS: A retrospective study of a prospectively 
      collected database identified heart failure patients who underwent bariatric 
      surgery between 1 January 2008 and 31 December 2017. Patients were followed up 
      12 months post-operatively. Cardiac investigations, functional capacity, cardiac 
      transplant candidacy, morbidity and length of stay were recorded. RESULTS: 
      Twenty-one patients (15 males, 6 females), mean age 48.7 +/- 10, BMI 46.2 kg/m(2) 
      (37.7-85.3) underwent surgery (gastric band (18), sleeve gastrectomy (2), 
      biliopancreatic diversion (1)). There were no loss to follow-up. There was 
      significant weight loss of 26.0 kg (5.0-78.5, p < 0.001), significant improvement 
      of left ventricular ejection fraction (LVEF) (10.0 +/- 11.9%, p < 0.001) and 
      significant reduction of 0.5 New York Heart Association (NYHA) classification 
      (0-2, p < 0.001). Multivariate models delineated the absence of atrial 
      fibrillation and pre-operative BMI < 49 kg/m(2) as significant predictors 
      (adjusted R-square 69%) for improvement of LVEF. Mean length of stay was 3.6 days 
      and in-hospital morbidity rate was 42.9%. One patient subsequently underwent a 
      heart transplant, and two patients were removed from the waitlist due to clinical 
      improvements. CONCLUSION: Bariatric surgery is safe and highly effective in obese 
      patients with severe heart failure with substantial improvements in cardiac 
      function and symptoms. A threshold pre-operative BMI of 49 kg/m(2) and absence of 
      atrial fibrillation may be significant predictors for improvement in cardiac 
      function. There is a role for bariatric surgery to act as a 
      bridge-to-transplantation or even ameliorate this requirement.
FAU - Yang, Tze Wei Wilson
AU  - Yang TWW
AD  - Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia. 
      wilyang.tw@gmail.com.
AD  - Department of Surgery, Monash University, Melbourne, Australia. 
      wilyang.tw@gmail.com.
FAU - Johari, Yazmin
AU  - Johari Y
AD  - Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia.
AD  - Department of Surgery, Monash University, Melbourne, Australia.
FAU - Burton, Paul R
AU  - Burton PR
AD  - Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia.
AD  - Department of Surgery, Monash University, Melbourne, Australia.
FAU - Earnest, Arul
AU  - Earnest A
AD  - Department of Epidemiology and Preventative Medicine, Monash University, 
      Melbourne, Australia.
FAU - Shaw, Kalai
AU  - Shaw K
AD  - Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia.
AD  - Department of Surgery, Monash University, Melbourne, Australia.
FAU - Hare, James L
AU  - Hare JL
AD  - Department of Cardiology, The Alfred, Melbourne, Australia.
FAU - Brown, Wendy A
AU  - Brown WA
AD  - Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia.
AD  - Department of Surgery, Monash University, Melbourne, Australia.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Obes Surg
JT  - Obesity surgery
JID - 9106714
SB  - IM
MH  - Adult
MH  - *Bariatric Surgery
MH  - Body Mass Index
MH  - Female
MH  - Gastrectomy
MH  - *Heart Failure/complications/surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Obesity, Morbid/surgery
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Bariatric surgery
OT  - Cardiac transplantation
OT  - Heart failure
EDAT- 2020/04/16 06:00
MHDA- 2021/04/15 06:00
CRDT- 2020/04/16 06:00
PHST- 2020/04/16 06:00 [pubmed]
PHST- 2021/04/15 06:00 [medline]
PHST- 2020/04/16 06:00 [entrez]
AID - 10.1007/s11695-020-04612-2 [pii]
AID - 10.1007/s11695-020-04612-2 [doi]
PST - ppublish
SO  - Obes Surg. 2020 Aug;30(8):2863-2869. doi: 10.1007/s11695-020-04612-2.