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Bariatric Surgery in Patients with Severe Heart Failure
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 tra...
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| Published in: | Obesity surgery 2020-08, Vol.30 (8), p.2863-2869 |
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| container_end_page | 2869 |
| container_issue | 8 |
| container_start_page | 2863 |
| container_title | Obesity surgery |
| container_volume | 30 |
| creator | Yang, Tze Wei Wilson Johari, Yazmin Burton, Paul R Earnest, Arul Shaw, Kalai Hare, James L Brown, Wendy A |
| description | 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
|
| doi_str_mv | 10.1007/s11695-020-04612-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2390146815</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2390146815</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-93f18a6ed0c5ddbcb959e7852895aa05e5c2b51ad66b0301f8e8097d8d8b9b273</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMo7rr6BzxIwYuX6iRp2uSoi-sKCwqr55C2U83SbdekVfbfG60f4MHTMMwz7wwPIccUzilAduEpTZWIgUEMSUpZzHbImGYgQ8vkLhmDSiGWivEROfB-BcBoytg-GXHGVACzMcmujLOmc7aIlr17QreNbBPdm85i0_nozXbP0RJf0WE0R-O6aGZs3Ts8JHuVqT0efdUJeZxdP0zn8eLu5nZ6uYgLnokuVryi0qRYQiHKMi9yJRRmUjCphDEgUBQsF9SUaZoDB1pJlKCyUpYyVznL-IScDbkb17706Du9tr7AujYNtr3XjCugSSqpCOjpH3TV9q4J32mW0ERRHiQFig1U4VrvHVZ64-zauK2moD-06kGrDlr1p9ZwY0JOvqL7fI3lz8q3xwDwAfBh1ASNv7f_iX0HBqWAmw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2414913461</pqid></control><display><type>article</type><title>Bariatric Surgery in Patients with Severe Heart Failure</title><source>Springer Link</source><creator>Yang, Tze Wei Wilson ; Johari, Yazmin ; Burton, Paul R ; Earnest, Arul ; Shaw, Kalai ; Hare, James L ; Brown, Wendy A</creator><creatorcontrib>Yang, Tze Wei Wilson ; Johari, Yazmin ; Burton, Paul R ; Earnest, Arul ; Shaw, Kalai ; Hare, James L ; Brown, Wendy A</creatorcontrib><description>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.</description><identifier>ISSN: 0960-8923</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-020-04612-2</identifier><identifier>PMID: 32291707</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Bariatric Surgery ; Body Mass Index ; Cardiac arrhythmia ; Cardiac function ; Ejection fraction ; Female ; Gastrectomy ; Gastrointestinal surgery ; Heart failure ; Heart Failure - complications ; Heart Failure - surgery ; Heart transplants ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Obesity, Morbid - surgery ; Original Contributions ; Retrospective Studies ; Stroke Volume ; Surgery ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>Obesity surgery, 2020-08, Vol.30 (8), p.2863-2869</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020</rights><rights>Springer Science+Business Media, LLC, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-93f18a6ed0c5ddbcb959e7852895aa05e5c2b51ad66b0301f8e8097d8d8b9b273</citedby><cites>FETCH-LOGICAL-c375t-93f18a6ed0c5ddbcb959e7852895aa05e5c2b51ad66b0301f8e8097d8d8b9b273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32291707$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Tze Wei Wilson</creatorcontrib><creatorcontrib>Johari, Yazmin</creatorcontrib><creatorcontrib>Burton, Paul R</creatorcontrib><creatorcontrib>Earnest, Arul</creatorcontrib><creatorcontrib>Shaw, Kalai</creatorcontrib><creatorcontrib>Hare, James L</creatorcontrib><creatorcontrib>Brown, Wendy A</creatorcontrib><title>Bariatric Surgery in Patients with Severe Heart Failure</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><addtitle>Obes Surg</addtitle><description>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.</description><subject>Adult</subject><subject>Bariatric Surgery</subject><subject>Body Mass Index</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac function</subject><subject>Ejection fraction</subject><subject>Female</subject><subject>Gastrectomy</subject><subject>Gastrointestinal surgery</subject><subject>Heart failure</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - surgery</subject><subject>Heart transplants</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Obesity, Morbid - surgery</subject><subject>Original Contributions</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>0960-8923</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kE1LxDAQhoMo7rr6BzxIwYuX6iRp2uSoi-sKCwqr55C2U83SbdekVfbfG60f4MHTMMwz7wwPIccUzilAduEpTZWIgUEMSUpZzHbImGYgQ8vkLhmDSiGWivEROfB-BcBoytg-GXHGVACzMcmujLOmc7aIlr17QreNbBPdm85i0_nozXbP0RJf0WE0R-O6aGZs3Ts8JHuVqT0efdUJeZxdP0zn8eLu5nZ6uYgLnokuVryi0qRYQiHKMi9yJRRmUjCphDEgUBQsF9SUaZoDB1pJlKCyUpYyVznL-IScDbkb17706Du9tr7AujYNtr3XjCugSSqpCOjpH3TV9q4J32mW0ERRHiQFig1U4VrvHVZ64-zauK2moD-06kGrDlr1p9ZwY0JOvqL7fI3lz8q3xwDwAfBh1ASNv7f_iX0HBqWAmw</recordid><startdate>20200801</startdate><enddate>20200801</enddate><creator>Yang, Tze Wei Wilson</creator><creator>Johari, Yazmin</creator><creator>Burton, Paul R</creator><creator>Earnest, Arul</creator><creator>Shaw, Kalai</creator><creator>Hare, James L</creator><creator>Brown, Wendy A</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20200801</creationdate><title>Bariatric Surgery in Patients with Severe Heart Failure</title><author>Yang, Tze Wei Wilson ; Johari, Yazmin ; Burton, Paul R ; Earnest, Arul ; Shaw, Kalai ; Hare, James L ; Brown, Wendy A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-93f18a6ed0c5ddbcb959e7852895aa05e5c2b51ad66b0301f8e8097d8d8b9b273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Bariatric Surgery</topic><topic>Body Mass Index</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac function</topic><topic>Ejection fraction</topic><topic>Female</topic><topic>Gastrectomy</topic><topic>Gastrointestinal surgery</topic><topic>Heart failure</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - surgery</topic><topic>Heart transplants</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Obesity, Morbid - surgery</topic><topic>Original Contributions</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Tze Wei Wilson</creatorcontrib><creatorcontrib>Johari, Yazmin</creatorcontrib><creatorcontrib>Burton, Paul R</creatorcontrib><creatorcontrib>Earnest, Arul</creatorcontrib><creatorcontrib>Shaw, Kalai</creatorcontrib><creatorcontrib>Hare, James L</creatorcontrib><creatorcontrib>Brown, Wendy A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Tze Wei Wilson</au><au>Johari, Yazmin</au><au>Burton, Paul R</au><au>Earnest, Arul</au><au>Shaw, Kalai</au><au>Hare, James L</au><au>Brown, Wendy A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bariatric Surgery in Patients with Severe Heart Failure</atitle><jtitle>Obesity surgery</jtitle><stitle>OBES SURG</stitle><addtitle>Obes Surg</addtitle><date>2020-08-01</date><risdate>2020</risdate><volume>30</volume><issue>8</issue><spage>2863</spage><epage>2869</epage><pages>2863-2869</pages><issn>0960-8923</issn><eissn>1708-0428</eissn><abstract>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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>32291707</pmid><doi>10.1007/s11695-020-04612-2</doi><tpages>7</tpages></addata></record> |
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| ispartof | Obesity surgery, 2020-08, Vol.30 (8), p.2863-2869 |
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| language | eng |
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| source | Springer Link |
| subjects | Adult Bariatric Surgery Body Mass Index Cardiac arrhythmia Cardiac function Ejection fraction Female Gastrectomy Gastrointestinal surgery Heart failure Heart Failure - complications Heart Failure - surgery Heart transplants Humans Male Medicine Medicine & Public Health Middle Aged Obesity, Morbid - surgery Original Contributions Retrospective Studies Stroke Volume Surgery Treatment Outcome Ventricular Function, Left |
| title | Bariatric Surgery in Patients with Severe Heart Failure |
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