Bariatric Surgery in Patients with Severe Heart Failure

Tze Wei Wilson Yang, Yazmin Johari, Paul R. Burton, Arul Earnest, Kalai Shaw, James L. Hare, Wendy A. Brown

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

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/m2 (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/m2 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/m2 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.

Original languageEnglish
Pages (from-to)2863-2869
Number of pages7
JournalObesity Surgery
Volume30
Issue number8
DOIs
Publication statusPublished - Aug 2020

Keywords

  • Bariatric surgery
  • Cardiac transplantation
  • Heart failure

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