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Goubar T, Kim S, Cistulli D, Fenton-Lee D, Rushworth RL, Macdonald PS, Keogh AM. Sleeve gastrectomy as a bridge to cardiac recovery - A retrospective comparative cohort study. JHLT OPEN 2025; 8:100224. [PMID: 40144731 PMCID: PMC11935463 DOI: 10.1016/j.jhlto.2025.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Background Obesity in patients with heart failure with reduced ejection fraction (HFrEF) increases morbidity and may preclude them from accessing advanced heart failure therapies. Bariatric surgery, specifically sleeve gastrectomy (SG), may improve eligibility for cardiac transplant; however, its impact on heart failure outcomes is not well defined. Methods We conducted a retrospective cohort study of patients with obesity (body mass index [BMI] ≥35 kg/m2) and (left ventricular ejection fraction [LVEF] ≤40%) who underwent SG at a tertiary heart transplant center. Outcomes were compared with controls matched for age, sex, LVEF, and BMI receiving standard care. We evaluated BMI, New York Heart Association (NYHA) functional class, medications, echocardiographic parameters, time to advanced heart failure therapies, and survival. Results Twenty patients (median BMI 42.8 kg/m², LVEF 25%) underwent SG compared to 40 matched patients. Both groups demonstrated reductions in BMI; however, weight loss was significantly greater in the treatment group (-9.9 [95% CI -12.2, -7.6] vs. -2.7 [-4.3, -1.1] kg/m², p < 0.05). Despite this, improvements in LVEF (+16.6% [10.2, 23.0] vs. +0.1% [-4.4, 4.7], p < 0.05) along with NYHA class (-0.8 [95% CI: -1.3, -0.3] vs. +0.4 [0.1, 0.7], p < 0.05) were only observed in those receiving SG. Overall survival was significantly higher in the treatment group [HR: 0.2 (0.07, 0.62), p < 0.01], which had no deaths compared to 35% in the comparison group. Conclusion In patients with HFrEF and obesity, SG is associated with significant improvements in cardiac function and survival compared to standard care, supporting its role as a safe and effective bridge to recovery or candidacy.
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Affiliation(s)
- Thomas Goubar
- St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia
- The University of Notre Dame, School of Medicine, Sydney, 160 Oxford St, Darlinghurst, NSW 2010, Australia
| | - Samuel Kim
- Northern Beaches Hospital, 105 Frenchs Forest Rd W, Frenchs Forest, Sydney, NSW 2086, Australia
| | - David Cistulli
- Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, Sydney, NSW 2050, Australia
| | - Douglas Fenton-Lee
- St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia
- The University of Notre Dame, School of Medicine, Sydney, 160 Oxford St, Darlinghurst, NSW 2010, Australia
| | - R. Louise Rushworth
- The University of Notre Dame, School of Medicine, Sydney, 160 Oxford St, Darlinghurst, NSW 2010, Australia
| | - Peter S. Macdonald
- St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia
| | - Anne M. Keogh
- St Vincent’s Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia
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Robertson S, Weeks P, Chow E, Gulbis B, Nathan S, Patarroyo-Aponte M, Gregoric I, Shah SK, Bajwa KS, Kar B. Evaluation of warfarin dose and INR time in therapeutic range in left ventricular assist device patients with sleeve gastrectomy. Int J Artif Organs 2025; 48:77-83. [PMID: 39956922 DOI: 10.1177/03913988251317820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2025]
Abstract
Sleeve gastrectomy is safe and effective in patients with left ventricular assist devices (LVADs) and morbid obesity to improve candidacy for transplantation and increase survival rates. Literature describing warfarin anticoagulation in this population is limited. A single-center, propensity score-matched, retrospective cohort study was conducted to determine if sleeve gastrectomy in LVAD-implanted patients has an effect on warfarin dose requirements in the outpatient setting. Patients were eligible for inclusion if they were 18 years of age or older, underwent LVAD implant at the study center, and were discharged from the hospital on warfarin therapy. They must have at least 8 weeks of available follow-up data post-discharge. Propensity matching was utilized to identify a non-sleeve gastrectomy LVAD-only patients for comparison. A total of 96 LVAD-only patients and 48 LVAD plus sleeve gastrectomy patients were included in the final analysis. Outpatient warfarin requirements increased from baseline over time in both groups, with no significant differences between groups except at month 12, with a mean total weekly dose of 38.1 ± 21.4 mg in the LVAD only group and 46.8 ± 18.6 mg in the LVAD with sleeve gastrectomy group (p = 0.05). The sleeve gastrectomy group had a significantly lower warfarin doses per kilogram of body weight until month 6 post-discharge. The percent time in therapeutic range was significantly lower in the SG group at the 8 week, 3 month, and 6 month interval time point. There were no significant differences in the incidence of bleeding or thromboembolic events.
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Affiliation(s)
- Stephanie Robertson
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Phillip Weeks
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Elaine Chow
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Brian Gulbis
- Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maria Patarroyo-Aponte
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Igor Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
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Pouwels S, Thaher O, Vladimirov M, Felsenreich DM, Pascotto B, Taha S, Bausch D, Oviedo RJ. Global collaborative research in metabolic and bariatric surgery (GCRMBS): current status and directions for the future. BMC Surg 2024; 24:367. [PMID: 39563353 PMCID: PMC11577625 DOI: 10.1186/s12893-024-02636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 10/15/2024] [Indexed: 11/21/2024] Open
Abstract
Obesity has been recognized as a chronic disorder by the World Health Organisation (WHO) and was first reported in the Paleolithic age. In the recent years there has not been an international collaborative that facilitates professional cooperation on a worldwide level to increase the output of high-level evidence in the fields of obesity treatment and metabolic and bariatric surgery (MBS). In other surgical and medical fields, international collaborative research networks have shown to increase the quality and amount of treatment-changing evidence. In general, Global Collaborative Research in MBS (GCRMBS) should have the following goals: (1) clinical specialty-based research in obesity and MBS, (2) designing research protocols and studies to generate long-term data in obesity and MBS, (3) understanding the uncommon/rare complications and events associated with obesity and MBS, (4) increasing the number of participants in research and (5) investigating ethical and racial disparities in bariatric research. This review gives an overview of the current status and the future of international collaborative research in MBS.
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Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, NRW, Germany.
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Omar Thaher
- Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, NRW, Germany
| | - Miljana Vladimirov
- Department of Surgery, University of Bielefeld - Campus Detmold, Detmold, NRW, Germany
| | | | - Beniamino Pascotto
- Department of General and Minimally Invasive Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Safwan Taha
- Department of Metabolic and Bariatric Surgery, Mediclinic Airport Road Hospital, Abu Dhabi, United Arab Emirates
| | - Dirk Bausch
- Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, NRW, Germany
| | - Rodolfo J Oviedo
- Nacogdoches Medical Center, Nacogdoches, TX, USA
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
- Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA
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4
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Ghanem OM, Pita A, Nazzal M, Johnson S, Diwan T, Obeid NR, Croome KP, Lim R, Quintini C, Whitson BA, Burt HA, Miller C, Kroh M. Obesity, organ failure, and transplantation: A review of the role of metabolic and bariatric surgery in transplant candidates and recipients. Am J Transplant 2024; 24:1534-1546. [PMID: 38951053 DOI: 10.1016/j.ajt.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/16/2024] [Accepted: 04/03/2024] [Indexed: 07/03/2024]
Abstract
Obesity is a risk factor for kidney, liver, heart, and pulmonary diseases, as well as failure. Solid organ transplantation remains the definitive treatment for the end-stage presentation of these diseases. Among many criteria for organ transplant, efficient management of obesity is required for patients to acquire transplant eligibility. End-stage organ failure and obesity are 2 complex pathologies that are often entwined. Metabolic and bariatric surgery before, during, or after organ transplant has been studied to determine the long-term effect of bariatric surgery on transplant outcomes. In this review, a multidisciplinary group of surgeons from the Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Transplant Surgery presents the current published literature on metabolic and bariatric surgery as a therapeutic option for patients with obesity awaiting solid organ transplantation. This manuscript details the most recent recommendations, pharmacologic considerations, and psychological considerations for this specific cohort of patients. Since level one evidence is not available on many of the topics covered by this review, expert opinion was implemented in several instances. Additional high-quality research in this area will allow for better recommendations and, therefore, treatment strategies for these complex patients.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Minnesota, USA.
| | - Alejandro Pita
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mustafa Nazzal
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Tayyab Diwan
- Department of Surgery, Mayo Clinic Rochester, Minnesota, USA
| | - Nabeel R Obeid
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Robert Lim
- Atrium Health Carolinas Medical Center, Wake Forest University School of Medicine, Charlotte, North Carolina, USA
| | - Cristiano Quintini
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bryan A Whitson
- Department of Surgery, Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, California, USA
| | - Charles Miller
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Bandea D, Vilallonga R, Nedelcu A, Gavril LG, Nedelcu M, Suciu BA. Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature. J Clin Med 2024; 13:4779. [PMID: 39200921 PMCID: PMC11355359 DOI: 10.3390/jcm13164779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Background: The diet and physical activity of the world's population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. Methods: We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease-heart failure (HF) and cardiac artery disease (CAD), types of revascularization-coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index-BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. Results: A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion-duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). Conclusions: Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials.
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Affiliation(s)
- Dan Bandea
- Onesti Municipal Hospital, 601048 Onesti, Romania;
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, 540142 Tîrgu Mureș, Romania;
| | - Ramon Vilallonga
- ELSAN, Clinique Bouchard, 13006 Marseille, France; (R.V.); (A.N.)
- Endocrine, Metabolic and Bariatric Unit, General Surgery Department, Hospital Vall d’Hebron, 08035 Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Anamaria Nedelcu
- ELSAN, Clinique Bouchard, 13006 Marseille, France; (R.V.); (A.N.)
| | - Laura Gabriela Gavril
- Anesthesia and Intensive Care Unit, Regiional Institute of Oncology, 700115 Iasi, Romania;
- Anesthesia and Intensive Care Unit Department, Faculty of Medicine “Gr. T. Popa”, University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, 13006 Marseille, France; (R.V.); (A.N.)
| | - Bogdan Andrei Suciu
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, 540142 Tîrgu Mureș, Romania;
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6
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Ghanem OM, Pita A, Nazzal M, Johnson S, Diwan T, Obeid NR, Croome KP, Lim R, Quintini C, Whitson BA, Burt HA, Miller C, Kroh M. Obesity, organ failure, and transplantation: a review of the role of metabolic and bariatric surgery in transplant candidates and recipients. Surg Endosc 2024; 38:4138-4151. [PMID: 38951240 PMCID: PMC11289013 DOI: 10.1007/s00464-024-10930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/03/2024] [Indexed: 07/03/2024]
Abstract
Obesity is a risk factor for kidney, liver, heart, and pulmonary diseases, as well as failure. Solid organ transplantation remains the definitive treatment for the end-stage presentation of these diseases. Among many criteria for organ transplant, efficient management of obesity is required for patients to acquire transplant eligibility. End-stage organ failure and obesity are 2 complex pathologies that are often entwined. Metabolic and bariatric surgery before, during, or after organ transplant has been studied to determine the long-term effect of bariatric surgery on transplant outcomes. In this review, a multidisciplinary group of surgeons from the Society of American Gastrointestinal and Endoscopic Surgeons and the American Society for Transplant Surgery presents the current published literature on metabolic and bariatric surgery as a therapeutic option for patients with obesity awaiting solid organ transplantation. This manuscript details the most recent recommendations, pharmacologic considerations, and psychological considerations for this specific cohort of patients. Since level one evidence is not available on many of the topics covered by this review, expert opinion was implemented in several instances. Additional high-quality research in this area will allow for better recommendations and, therefore, treatment strategies for these complex patients.
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Affiliation(s)
- Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
| | - Alejandro Pita
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mustafa Nazzal
- Department of Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Tayyab Diwan
- Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Nabeel R Obeid
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Robert Lim
- Atrium Health Carolinas Medical Center, Wake Forest University School of Medicine, Charlotte, NC, USA
| | - Cristiano Quintini
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, CA, USA
| | - Charles Miller
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew Kroh
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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7
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Palenzuela DL, Agarwal D, Flanders K, Coglianese E, Tsao L, D'Alessandro D, Lewis GD, Fitzsimons M, Gee D. A second chance for a new heart? The role of metabolic and bariatric surgery in patients with end-stage heart failure. J Gastrointest Surg 2024; 28:389-393. [PMID: 38583888 DOI: 10.1016/j.gassur.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Obesity is an independent risk factor for heart failure (HF). Substantial weight loss has been shown to reverse obesity-related cardiomyopathy. This study aimed to report our institution's experience with laparoscopic sleeve gastrectomy (LSG) in patients with morbid obesity and end-stage HF. METHODS Between 2018 and 2022, 26 patients with end-stage HF were referred for LSG. Of 26 patients, 16 underwent an operation, and 10 did not. After institutional review board approval, a retrospective electronic medical record review was performed to evaluate (i) age, (ii) preoperative weight, (iii) decrease in body mass index (BMI) score, (iv) whether the patient underwent heart transplantation, and (v) mortality. Data analysis was performed using Stata/SE (version 17.0; StataCorp). The Wilcoxon rank-sum test was used to compare continuous variables between the cohorts, and the Pearson chi-square test was used for binary variables with Bonferroni correction applied. RESULTS The LSG and non-LSG cohorts had comparable ages (P = .088) and starting BMI score (P = .918), and a proportion of patients had a ventricular assist device (P = .191). Patients who underwent LSG lost significantly more weight than the patients who did not, with an average decrease in BMI score of 8.9 kg/m2 (SD, ±6.13) and 1.1 kg/m2 (SD, ±4.10), respectively (P = .040). Of note, 6 patients (37.5%) who underwent LSG eventually underwent transplantation, compared with 2 patients (20.0%) from the matched cohort (P = .884). Of the 26 patients, there were 6 deaths: 2 (12.5%) in the LSG cohort and 4 (40.0%) in the non-LSG cohort (P = .525). CONCLUSION LSG may be safe and effective for weight loss in patients with HF. This operation may provide patients affected by obesity with end-stage HF the lifesaving opportunity to achieve transplant candidacy.
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Affiliation(s)
- Deanna L Palenzuela
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
| | - Divyansh Agarwal
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Karen Flanders
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Erin Coglianese
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Lana Tsao
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - David D'Alessandro
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Gregory D Lewis
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Michael Fitzsimons
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, United States
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8
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Tsai C, Dolan P, Moss N, Sandoval AF, Roldan J, Herron DM. Sleeve gastrectomy facilitates weight loss and permits cardiac transplantation in patients with severe obesity and a left ventricular assist device (LVAD). Surg Endosc 2023; 37:8655-8662. [PMID: 37495848 DOI: 10.1007/s00464-023-10264-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Patients suffering from advanced heart failure may undergo left ventricular assist device (LVAD) placement as a bridge to cardiac transplantation. However, those with a BMI above 35 kg/m2 are generally not considered eligible for transplant due to their elevated cardiac risk. We review our experience with bariatric surgery in this high-risk population to assess its safety and efficacy in reducing BMI to permit cardiac transplantation. METHODS We retrospectively reviewed all patients on durable LVAD support who underwent sleeve gastrectomy (SG) at Mount Sinai Hospital between August 2018 and December 2022. Electronic medical records were reviewed to analyze patient demographics, surgical details, and outcomes regarding weight loss and heart transplantation. RESULTS We identified twelve LVAD patients who underwent SG. Three were performed laparoscopically and 9 via robotic approach. Four patients (33.3%) underwent an orthotopic heart transplant (OHTx). Half of these patients were female. For patients who underwent OHTx, mean age at LVAD placement was 41.0 (R30.6-52.2), at SG was 43.9 (R32.7-55.0) and at OHTx was 45.3 years (R33.3-56.8). Mean BMI increased from 38.8 at LVAD placement to 42.5 prior to SG. Mean time from SG to OHTx was 17.9 months (R6-7-27.5) during which BMI decreased to mean 32.8 at the time of OHTx. At most recent follow-up, mean BMI was 31.9. All patients were anticoagulated prior to surgery; one required return to the operating room on post-operative day 1 after SG for bleeding and one was re-admitted on post-operative day 7 for hematochezia treated conservatively. CONCLUSION SG is a safe and effective operation in patients with severe obesity and heart failure requiring an LVAD. 66.7% of our cohort achieved target BMI < 35 and 33.3% underwent heart transplantation. Longer term follow-up is needed to clarify full bridge-to-transplant rate and long-term survival outcomes.
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Affiliation(s)
- Catherine Tsai
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Patrick Dolan
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Noah Moss
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | | | - Julie Roldan
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | - Daniel M Herron
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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9
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Sharma I, Nakanishi H, Hage K, Marrero K, Diwan TS, daSilva-deAbreu A, Davis SS, Clapp B, Ghanem OM. Bariatric surgery and left ventricular assist device in patients with heart failure: A systematic review and meta-analysis. Am J Surg 2023; 226:340-349. [PMID: 37355375 DOI: 10.1016/j.amjsurg.2023.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/21/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The role of metabolic and bariatric surgery (MBS), in synergy with left ventricular assist device (LVAD) implantation, in the scope of end-stage heart failure management for patients with severe obesity is not well elucidated. METHODS We conducted a meta-analysis using Cochrane, Embase, PubMed, and Scopus databases to include articles from their inception to November 2022. RESULTS A total of 271 patients who underwent MBS during or after the LVAD implantation were included from eleven separate studies. After surgery, 67.4% of patients were listed on the heart transplant waitlist with 32.5% undergoing a successful transplant. We reported a mean listing time of 13.8 months. Finally, the pooled postoperative complication rate, 30-day readmission rate, and one-year mortality rate were 47.6%, 23.6% and 10.2% respectively. CONCLUSIONS MBS and LVAD is a safe and effective approach to bridge patients with severe obesity and end-stage heart failure for definitive heart transplantation.
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Affiliation(s)
- Ishna Sharma
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Karl Hage
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Katie Marrero
- Carle Foundation Hospital General Surgery Residency, Champaign, IL, USA
| | - Tayyab S Diwan
- Division of Transplantation, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Scott S Davis
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, El Paso, TX, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
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10
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Abebe TB, Doyle MB, Khan A, Eagon JC, Dimou FM, Eckhouse SR, Shakhsheer BA. Should Bariatric Surgery Play a Larger Role in the Management of Pediatric Patients with Severe Obesity and End-Stage Organ Disease? Obes Surg 2023; 33:2585-2587. [PMID: 37273156 DOI: 10.1007/s11695-023-06661-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tsehay B Abebe
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Majella B Doyle
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Adeel Khan
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J Christopher Eagon
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shaina R Eckhouse
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Baddr A Shakhsheer
- Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA
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11
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Herbst DA, Iyengar A, Weingarten ,N, Helmers MR, Kim ,ST, Atluri P. Failure to rescue: obesity increases the risk of mortality following early graft failure in heart transplantation in UNOS database patients. Interact Cardiovasc Thorac Surg 2022; 35:6571810. [PMID: 35445717 PMCID: PMC9419685 DOI: 10.1093/icvts/ivac102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- David Alan Herbst
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
| | - , Noah Weingarten
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
| | - Mark R Helmers
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
| | - , Samuel T Kim
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania , Philadelphia, PA, USA
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12
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Bariatric Weight Loss Surgery Improves Systolic Function in Obese Patients with Heart Failure. Curr Probl Cardiol 2022:101231. [DOI: 10.1016/j.cpcardiol.2022.101231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/22/2022]
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13
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Zaliznyak M, Stern L, Cole R, Shen A, Nishihara K, Runyan C, Fishman A, Olanisa L, Olman M, Singer-Englar T, Luong E, Cheng S, Moriguchi J, Kobashigawa J, Esmailian F, Kittleson MM. Mechanical Circulatory Support as a Bridge-to-Transplant Candidacy: When Does It Work? ASAIO J 2022; 68:499-507. [PMID: 34074853 DOI: 10.1097/mat.0000000000001500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Durable mechanical circulatory support (dMCS) devices can be offered as a bridge-to-transplant (BTT) or as a bridge-to-candidacy (BTC) strategy for candidates with contraindications to transplant listing, including pulmonary hypertension (BTC-PH), morbid obesity (BTC-Obes), social issues (BTC-Soc), or chronic illness (BTC-Illness). An understanding of the trajectory of BTC patients could guide future triage of advanced heart failure patients who are not candidates for transplantation. We performed a retrospective review all patients who underwent dMCS implantation as either BTT (206 patients) or BTC (114 patients) at our center from January 1, 2010, to March 31, 2020. There was no significant difference in mortality between BTC patients and BTT patients. Compared with the BTT group, significantly more patients in the BTC-PH group were transplanted (81% vs. 63%; p < 0.05) and significantly fewer patients in the BTC-Obes group (44%; p < 0.05) and BTC-Soc group (39%; p < 0.05) were transplanted. Additionally, the readmission rate was higher for those in the BTC-Obes (6.2 vs. 2.1; p < 0.05) and BTC-Soc (3.9 vs. 2.1; p < 0.05) groups. Bridge-to-candidacy patients generally had poorer post-dMCS trajectories than BTT patients. Centers should not be dissuaded from pursuing a BTC strategy for qualified patients; however, careful consideration of potential adverse outcomes is necessary.
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Affiliation(s)
- Michael Zaliznyak
- From the Departments of Cardiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
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14
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García Ruiz de Gordejuela A, Ibarzabal A, Osorio J. Bariatric Surgery and Solid-Organ Transplantation. Transplant Proc 2022; 54:87-90. [PMID: 34973842 DOI: 10.1016/j.transproceed.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.
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Affiliation(s)
- Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, General Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Clinic Hospital Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Osorio
- Bariatric Surgery Unit, General Surgery Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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15
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Ng M, Rodgers B, Rehman S, Nathan SS, Bajwa KS, Shah SK, Akkanti BH, Jumean MF, Kumar S, Dressel JL, Radovancevic R, Felinski MM, Kar B, Gregoric ID. Left Ventricular Assist Device Support and Longitudinal Sleeve Gastrectomy Combined With Diet in Bridge to Heart Transplant. Tex Heart Inst J 2022; 49:478098. [PMID: 35201356 DOI: 10.14503/thij-20-7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Combining left ventricular assist device (LVAD) implantation and longitudinal sleeve gastrectomy may enable patients with morbid obesity to lose enough weight for heart transplant eligibility. In a retrospective study, we evaluated long-term outcomes of patients with body mass indexes ≥35 who underwent LVAD implantation and longitudinal sleeve gastrectomy during the same hospitalization (from January 2013 through July 2018) and then adhered to a dietary protocol. We included 22 patients (mean age, 49.9 ± 12.5 yr; mean preoperative body mass index, 43.3 ± 6.2). Eighteen months after gastrectomy, all 22 patients were alive, and 16 (73%) achieved a body mass index of less than 35. Myocardial recovery in 2 patients enabled LVAD removal. As of October 2020, 10 patients (45.5%) had undergone heart transplantation, 5 (22.3%) were waitlisted, 5 (22.3%) still had a body mass index ≥35, and 2 (9%) had died. With LVAD support, longitudinal sleeve gastrectomy, and dietary protocols, most of our patients with morbid obesity and advanced heart failure lost enough weight for transplant eligibility. Support from physicians and dietitians can maximize positive results in these patients.
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Affiliation(s)
- Mandy Ng
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Beverly Rodgers
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Saadiya Rehman
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Sriram S Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Kulvinder S Bajwa
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shinil K Shah
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Bindu H Akkanti
- Division of Critical Care Medicine, University of Texas McGovern Medical School, Houston, Texas.,Division of Pulmonary and Sleep Medicine, University of Texas McGovern Medical School, Houston, Texas
| | - Marwan F Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jennifer L Dressel
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa M Felinski
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
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16
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Ryan CT, Santiago A, Tariq N, Lamba HK. Effect of Laparoscopic Sleeve Gastrectomy on Heart Transplant Status in 4 Patients with Left Ventricular Assist Devices. Tex Heart Inst J 2021; 47:284-289. [PMID: 33472222 DOI: 10.14503/thij-19-7161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Bariatric surgery helps many morbidly obese patients lose substantial weight. However, few data exist on its long-term safety and effectiveness in patients who also have continuous-flow left ventricular assist devices and in whom heart transplantation is contemplated. We retrospectively identified patients at our institution who had undergone ventricular assist device implantation and subsequent laparoscopic sleeve gastrectomy from June 2015 through September 2017, and we evaluated their baseline demographic data, preoperative characteristics, and postoperative outcomes. Four patients (3 men), ranging in age from 32 to 44 years and in body mass index from 40 to 57, underwent sleeve gastrectomy from 858 to 1,849 days after left ventricular assist device implantation to treat nonischemic cardiomyopathy. All had multiple comorbidities. At a median follow-up duration of 42 months (range, 24-47 mo), median body mass index decreased to 31.9 (range, 28.3-44.3) at maximal weight loss, with a median percentage of excess body mass index lost of 72.5% (range, 38.7%-87.4%). After achieving target weight, one patient was listed for heart transplantation, another awaited listing, one was kept on destination therapy because of positive drug screens, and one regained weight and remained ineligible. On long-term follow-up, laparoscopic sleeve gastrectomy appears to be safe and feasible for morbidly obese patients with ventricular assist devices who must lose weight for transplantation consideration. Additional studies are warranted to evaluate this weight-loss strategy after transplantation and immunosuppression.
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Affiliation(s)
- Christopher T Ryan
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Adriana Santiago
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Nabil Tariq
- Bariatric and Metabolic Surgery Center, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
| | - Harveen K Lamba
- Division of Cardiothoracic Transplantation and Mechanical Circulatory Support, Department of Surgery; Baylor College of Medicine, Houston, Texas 77030
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17
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Scheibe CL, Pinto LEV, Valadão JA, de Oliveira CMB, Moura ECR, Campelo GP, de Lima RC, Freire TT, de Oliveira EJSG, da Cunha Leal P. Laparoscopic Bypass in Morbidly Obese Patient with End-Stage Heart Failure: Case Report. Obes Surg 2021; 31:5059-5062. [PMID: 34212344 DOI: 10.1007/s11695-021-05549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
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18
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Kindel TL, Higgins RM, Lak K, Gould J, Baumann Kreuziger L, Mohammed A, Gaglianello N, Ishizawar D. Bariatric surgery in patients with advanced heart failure: A proposed multi-disciplinary pathway for surgical care in medically complex patients. Surgery 2021; 170:659-663. [PMID: 34052027 DOI: 10.1016/j.surg.2021.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/22/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to develop a multi-disciplinary care pathway to minimize perioperative complications in patients with advanced heart failure undergoing bariatric surgery. Patients with severe obesity and heart failure carry increased perioperative surgical risk compared to patients with no heart failure due to the severity of their cardiac disease state and associated comorbidities. Our bariatric program routinely excluded patients with advanced heart failure from undergoing bariatric surgery due to the high reported perioperative risk. However, knowing the potential beneficial impact of bariatric surgery for advanced heart failure, our program hoped that the thoughtful development of a perioperative pathway before inclusion of patients with advanced heart failure in the bariatric surgery program could minimize the morbidity of these high-risk patients in comparison to prior publications in the literature. METHODS Two multi-disciplinary care pathways were developed, including advanced heart failure, anticoagulation specialists, and transplant cardiologists, to optimize bariatric care for severely obese patients with advanced heart failure with or without mechanical circulatory support and implementation was evaluated for short-term 30-day complications and 6 month cardiac and weight-loss outcomes. RESULTS Two multi-disciplinary care pathways were developed and implemented on 5 patients with heart failure with reduced ejection fraction (pathway 1) and 3 patients requiring mechanical circulatory support (pathway 2). There were no in-hospital complications or mortality following either pathway, and there was only 1 emergency room visit and 1 re-admission. The average length of stay for patients with heart failure with reduced ejection fraction without mechanical circulatory support was 2.4 days and for heart failure with reduced ejection fraction with mechanical circulatory support was 4.3 days. Three patients met body mass index criteria for transplant listing at 6 months. Ejection fraction increased an average of 9% at 6 months postoperatively for patients with heart failure with reduced ejection fraction not requiring mechanical circulatory support. CONCLUSION With multi-disciplinary care pathway development designed to maximize safety by intensely supporting preoperative cardiac optimization and medication titration postoperatively, bariatric surgery can be performed in patients with advanced heart failure with or without mechanical circulatory support, allowing patients the opportunity for weight loss as a bridge to transplant or potentially meaningful cardiac recovery.
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Affiliation(s)
- Tammy L Kindel
- Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Rana M Higgins
- Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Kate Lak
- Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jon Gould
- Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Lisa Baumann Kreuziger
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Asim Mohammed
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Nunzio Gaglianello
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - David Ishizawar
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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19
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Brathwaite BM, Howell RS, Petrone P, Brathwaite CEM. Safety of Bariatric Surgery in Patients With Congestive Heart Failure: Results of an 11-Year Retrospective Study. Am Surg 2021; 88:1195-1200. [PMID: 33522255 DOI: 10.1177/0003134821991975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Congestive heart failure (CHF) is a known risk factor for increased postoperative morbidity. However, the safety in patients with CHF has not been well established. The objective of this study was to assess the safety of surgery in patients with a history of CHF undergoing bariatric surgical procedures. METHODS Retrospective review of a prospectively maintained Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence database. Patients with known CHF undergoing bariatric procedures over an 11-year period were reviewed. RESULTS Over the 11-year period, 4470 total bariatric surgeries were performed, of which 41 (.92%) patients had known CHF. Twenty-one patients were men (51.2%) with a mean age of 55.8 years and mean body mass index (BMI) of 51.9. Comorbidities included hypertension (87.8%), obstructive sleep apnea (80.5%), osteoarthritis (63.4%), gastroesophageal reflux disease (56%), and diabetes (53.7%). Surgical procedures included 16 sleeve gastrectomies (SGs) (39%), 11 Roux-en-Y gastric bypasses (RYGBs) (26.8%), 10 laparoscopic adjustable gastric bands (LAGBs) (24.4%), 1 removal of a gastric band and conversion to SG (2.4%), 1 removal of a gastric band to RYGB (2.4%), 1 gastric band over RYGB pouch (2.4%), and 1 gastric band replacement (2.4%). All cases were performed minimally invasively (73.2% laparoscopic and 26.8% robotic). Mean LOS was 2.53 days. Thirty-day complications included 2 readmissions (4.9% [1 small bowel obstruction and 1 pulmonary edema]), 1 reoperation (2.4% [small bowel obstruction]), and 1 mortality (2.4%) on postoperative day 30 unrelated to the surgery. CONCLUSIONS Bariatric surgery can be performed safely in patients with CHF.
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Affiliation(s)
- Barbara M Brathwaite
- 16038Stony Brook School of Nursing, Stony Brook University, Stony Brook, NY, USA.,Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Raelina S Howell
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Patrizio Petrone
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
| | - Collin E M Brathwaite
- Department of Surgery, 24998NYU Langone Hospital-Long Island, NYU Long Island School of Medicine, Mineola, New York, USA
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20
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Nathan SS, Iranmanesh P, Gregoric ID, Akay MH, Kumar S, Akkanti BH, Salas de Armas IA, Patel M, Felinski MM, Shah SK, Bajwa KS, Kar B. Regression of severe heart failure after combined left ventricular assist device placement and sleeve gastrectomy. ESC Heart Fail 2021; 8:1615-1619. [PMID: 33491335 PMCID: PMC8006616 DOI: 10.1002/ehf2.13194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 12/21/2022] Open
Abstract
Patients who suffer morbid obesity and heart failure (HF) present unique challenges. Two cases are described where concomitant use of laparoscopic sleeve gastrectomy (LSG) and left ventricular assist device (LVAD) placement enabled myocardial recovery and weight loss resulting in explantation. A 29‐year‐old male patient with a body mass index (BMI) of 59 kg/m2 and severe HF with a left ventricular ejection fraction (LVEF) of 20–25% underwent concomitant LSG and LVAD placement. Sixteen months after surgery, his BMI was reduced to 34 kg/m2 and his LVEF improved to 50–55%. A second 41‐year‐old male patient with a BMI of 44.8 kg/m2 with severe HF underwent the same procedures. Twenty‐four months later, his BMI was 31.1 kg/m2 and his LVEF was 50–55%. In both cases, the LVAD was successfully explanted and patients remain asymptomatic. HF teams should consult and collaborate with bariatric experts to determine if LSG may improve the outcomes of their HF patients.
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Affiliation(s)
- Sriram S Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Pouya Iranmanesh
- Department of Surgery, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Mehmet H Akay
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Bindu H Akkanti
- Division of Critical Care Medicine, Department of Medicine, UTHealth, Houston, TX, USA
| | - Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Manish Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
| | - Melissa M Felinski
- Department of Surgery, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Kulvinder S Bajwa
- Department of Surgery, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, UTHealth, 6400 Fannin St, Suite 2350, Houston, TX, 77030, USA
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21
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Clinical Outcomes, Trends in Weight, and Weight Loss Strategies in Patients With Obesity After Durable Ventricular Assist Device Implantation. Curr Heart Fail Rep 2021; 18:52-63. [PMID: 33420916 DOI: 10.1007/s11897-020-00500-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To discuss clinical outcomes, changes in weight, and weight loss strategies of patients with obesity post left ventricular assist device (LVAD) implantation. RECENT FINDINGS Despite increased complications in patients with obesity after LVAD implantation, survival is comparable to patients without obesity. A minority of patients with obesity lose significant weight and become eligible for heart transplantation after LVAD implantation. In fact, a great majority of such patients gain weight post-implantation. Obesity by itself should not be considered prohibitive for LVAD therapy but, rather, should be incorporated into the overall risk assessment for LVAD implantation. Concerted strategies should be developed to promote sustainable weight loss in patients with obesity and LVAD to improve quality of life, eligibility, and outcomes after heart transplantation. Investigation of the long-term impact of weight loss on patients with obesity with LVAD is warranted.
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22
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Pisansky AJB, Burbano-Vera N, Stopfkuchen-Evans MF. Anesthetic management of a patient with left ventricular assist device undergoing robotic laparoscopic prostatectomy: a case report. JA Clin Rep 2020; 6:57. [PMID: 32712732 PMCID: PMC7382672 DOI: 10.1186/s40981-020-00364-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Patients with left ventricular assist devices (LVAD) require specific anesthetic and hemodynamic considerations. We report the specific anesthetic preparation and management in this scenario. Case presentation We present the case of a 66-year-old male with a HeartMate II LVAD undergoing robotic prostatectomy for prostate cancer in the steep Trendelenburg position. We employed central venous and radial arterial access, LVAD pump parameters, near-infrared sensor of cerebral oximetry, and transesophageal echocardiography for monitoring. Hemodynamics were managed with nicardipine, dobutamine, epinephrine, and phenylephrine during abdominal insufflation, operative positioning, and desufflation. The patient had a successful procedure, was discharged on postoperative day 2, and achieved surgical cure of his prostate cancer. Discussion By presenting the first detailed account of anesthetic management in this scenario, we provide a clinical vignette for use by the clinical anesthesiologist in his or her preparation prior to caring for this type of patient.
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23
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Tabucanon T, Wilcox J, Tang WHW. Does Weight Loss Improve Clinical Outcomes in Overweight and Obese Patients with Heart Failure? Curr Diab Rep 2020; 20:75. [PMID: 33231788 DOI: 10.1007/s11892-020-01367-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Obesity increases the risk of new onset heart failure (HF), and particularly HF with preserved ejection fraction (HFpEF). Despite the observations of favorable clinical outcomes in HF patients with obesity in general, sometimes referred to as the "obesity paradox," it is important to recognize that severe obesity is associated with worse clinical outcomes. This review summarizes the effects of obesity treatment on cardiovascular health and HF clinical outcomes. RECENT FINDINGS Treatment for obesity utilizes a variety of modalities to achieve purposeful weight loss including lifestyle intervention, medications, and bariatric surgery. There are a cluster of benefits of obesity treatment in terms of clinical outcomes in HF. The mechanisms of these benefits include both weight loss-dependent and weight loss-independent mechanisms. Obesity treatment is safe and associated with favorable clinical outcomes across the spectrum of the HF population. The potential benefits are facilitated through multiple mechanisms.
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Affiliation(s)
- Thida Tabucanon
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
- Thammasat Heart Center, Thammasat University Hospital, Khlong Luang, Pathum Thani, Thailand
| | - Jennifer Wilcox
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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24
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Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese Patients: a Systematic Review and Meta-Analysis. Cardiol Rev 2020; 30:1-7. [PMID: 33165086 DOI: 10.1097/crd.0000000000000346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Class 2 obesity or greater (body mass index [BMI] >35 kg/m) is a relative contraindication for heart transplant due to its associated perioperative risks and mortality. Whether bariatric surgery can act as a potential bridging procedure to heart transplantation is unknown. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery on improving transplant candidacy in patients with end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed databases were searched up to September 2019 for studies that performed bariatric surgery on patients with severe obesity and ESHF. Outcomes of interest included incidence of patients listed for heart transplantation after bariatric surgery, proportion of patients that successfully received transplant, the change in BMI after bariatric surgery, and 30-day complications. Pooled estimates were calculated using a random effects meta-analysis of proportions. Eleven studies with 98 patients were included. Mean preoperative BMI was 44.9 (2.1) kg/m and BMI after surgery was 33.2 (2.3) kg/m with an absolute BMI reduction of 26.1%. After bariatric surgery, 71% (95% confidence interval [CI], 55%-86%) of patients with ESHF were listed for transplantation. The mean time from bariatric surgery to receiving a heart transplant was 14.9 (4.0) months. Of the listed patients, 57% (95% CI, 39-74%) successfully received heart transplant. The rate of 30-day mortality after bariatric surgery was 0%, and the 30-day major and minor complications after bariatric surgery was 28% (95% CI, 10%-49%). Bariatric surgery can facilitate sustained weight loss in obese patients with ESHF, improving heart transplant candidacy and the incidence of transplantation.
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Orandi BJ, Purvis JW, Cannon RM, Smith AB, Lewis CE, Terrault NA, Locke JE. Bariatric surgery to achieve transplant in end-stage organ disease patients: A systematic review and meta-analysis. Am J Surg 2020; 220:566-579. [PMID: 32600846 PMCID: PMC7484004 DOI: 10.1016/j.amjsurg.2020.04.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND As obesity prevalence grows, more end-stage organ disease patients will be precluded from transplant. Numerous reports suggest bariatric surgery in end-stage organ disease may help patients achieve weight loss sufficient for transplant listing. METHODS We performed a systematic review/meta-analysis of studies of bariatric surgery to achieve solid organ transplant listing. RESULTS Among 82 heart failure patients, 40.2% lost sufficient weight for listing, 29.3% were transplanted, and 8.5% had sufficient improvement with weight loss they no longer required transplantation. Among 28 end-stage lung disease patients, 28.6% lost sufficient weight for listing, 7.1% were transplanted, and 14.3% had sufficient improvement following weight loss they no longer required transplant. Among 41 cirrhosis patients, 58.5% lost sufficient weight for listing, 41.5% were transplanted, and 21.9% had sufficient improvement following weight loss they no longer required transplant. Among 288 end-stage/chronic kidney disease patients, 50.3% lost sufficient weight for listing and 29.5% were transplanted. CONCLUSIONS Small sample size and publication bias are limitations; however, bariatric surgery may benefit select end-stage organ disease patients with obesity that precludes transplant candidacy.
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Affiliation(s)
- Babak J Orandi
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States.
| | - Joshua W Purvis
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
| | - Robert M Cannon
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
| | - A Blair Smith
- University of Alabama at Birmingham Schools of Medicine, Department of Anesthesia, United States
| | - Cora E Lewis
- University of Alabama at Birmingham Schools of Medicine, Department of Medicine, United States; University of Alabama at Birmingham Schools of Medicine, Public Health, United States
| | - Norah A Terrault
- University of Southern California Keck School of Medicine, Department of Medicine, United States
| | - Jayme E Locke
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
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Diwan TS, Lee TC, Nagai S, Benedetti E, Posselt A, Bumgardner G, Noria S, Whitson BA, Ratner L, Mason D, Friedman J, Woodside KJ, Heimbach J. Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic. Am J Transplant 2020; 20:2143-2155. [PMID: 31965711 DOI: 10.1111/ajt.15784] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 01/25/2023]
Abstract
The increasing obesity epidemic has major implications in the realm of transplantation. Patients with obesity face barriers in access to transplant and unique challenges in perioperative and postoperative outcomes. Because of comorbidities associated with obesity, along with the underlying end-stage organ disease leading to transplant candidacy, these patients may not even be referred for transplant evaluation, much less be waitlisted or actually undergo transplant. However, the use of bariatric surgery in this population can help optimize the transplant candidacy of patients with obesity and end-stage organ disease and improve perioperative and postoperative outcomes. We review the impact of obesity on kidney, liver, and cardiothoracic transplant candidates and recipients and explore potential interventions to address obesity in these populations.
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Affiliation(s)
| | | | | | | | - Andrew Posselt
- University of California at San Francisco, San Francisco, California, USA
| | | | | | | | - Lloyd Ratner
- Columbia University Medical Center, New York, New York, USA
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27
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Ventricular Assist Device Implantation and Bariatric Surgery: A Route to Transplantation in Morbidly Obese Patients with End-Stage Heart Failure. ASAIO J 2020; 67:163-168. [DOI: 10.1097/mat.0000000000001212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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28
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Bariatric Surgery in End-Stage Heart Failure: Feasibility in Successful Attainment of a Target Body Mass Index. J Card Fail 2020; 26:944-947. [PMID: 32428670 DOI: 10.1016/j.cardfail.2020.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Orthotopic heart transplantation (OHT) is contraindicated in morbidly obese patients with end-stage heart failure (HF), for whom cardiac allograft is the only means for long-term survival. Bariatric surgery may allow them to achieve target body mass index (BMI) for OHT METHODS: From 4/2014 to 12/2018, 26 morbidly obese HF patients who did not meet BMI eligibility criteria for OHT underwent laparoscopic bariatric surgery. Outcomes of interest were median difference in BMI, number of patients achieving target BMI for OHT, and 30-day mortality. RESULTS Median age was 49 (IQR 14) years, and 13 (50%) were women. HF was mainly systolic (15 patients, 58%). The median LVEF was 27% (IQR 37%). At the time of bariatric surgery, 12 (46%) patients had mechanical circulatory support: 2 (8%) concomitant left ventricular assist device (LVAD) placements, 8 (31%) LVAD already-in-place, and 2 (8%) intra-aortic balloon pumps. There was no 30-day mortality, but one mortality on postoperative day 48. Over a median follow-up of 6 months (range 0-36 months, IQR 17), there was a significant reduction in BMI (p<0.0001). The median postoperative BMI was 36.7 (IQR 8.7), compared to preoperative median BMI of 42.7 (IQR 9.4). Target BMI of < 35 was achieved in 11 (42%) patients. Three patients (12%) have undergone OHT. CONCLUSION Bariatric surgery in end-stage HF is feasible and results in a high number of patients achieving target BMI, increasing their probability of undergoing OHT. The presence of a LVAD should not preclude these patients from undergoing a bariatric intervention.
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29
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Van Aelst P, Deleus E, Van der Schueren B, Meyns B, Vandersmissen K, Lannoo M. Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device—Case Series and Review of Literature. Obes Surg 2020; 30:3628-3633. [DOI: 10.1007/s11695-020-04642-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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30
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Guglin M, Zucker MJ, Borlaug BA, Breen E, Cleveland J, Johnson MR, Panjrath GS, Patel JK, Starling RC, Bozkurt B. Evaluation for Heart Transplantation and LVAD Implantation. J Am Coll Cardiol 2020; 75:1471-1487. [DOI: 10.1016/j.jacc.2020.01.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022]
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31
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Sanches E, Timmermans M, Topal B, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S, Proczko M, Stepaniak PS, Pujol Rafols J, Mahawar K, Buise MP, Neimark A, Severin R, Pouwels S. Cardiac remodeling in obesity and after bariatric and metabolic surgery; is there a role for gastro-intestinal hormones? Expert Rev Cardiovasc Ther 2019; 17:771-790. [PMID: 31746657 DOI: 10.1080/14779072.2019.1690991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Obesity is associated with various diseases such as type 2 diabetes, hypertension, obstructive sleep apnea syndrome (OSAS), metabolic syndrome, and cardiovascular diseases. It affects several organ systems, including the pulmonary and cardiac systems. Furthermore, it induces pulmonary and cardiac changes that can result in right and/or left heart failure.Areas covered: In this review, authors provide an overview of obesity and cardiovascular remodeling, the individual actions of the gut hormones (like GLP-1 and PYY), the effects after bariatric/metabolic surgery and its influence on cardiac remodeling. In this review, we focussed and searched for literature in Pubmed and The Cochrane library (from the earliest date until April 2019), regarding cardiac function changes before and after bariatric surgery and literature regarding changes in gastrointestinal hormones.Expert opinion: Regarding the surgical treatment of obesity and metabolic diseases there is recognition of the importance of both weight loss (bariatric surgery) and improvement in metabolic milieu (metabolic surgery). A growing body of evidence further suggests that bariatric surgical procedures [like the Sleeve Gastrectomy (SG), Roux-en Y Gastric Bypass (RYGB), or One Anastomosis Gastric Bypass (OAGB)] have can improve outcomes of patients suffering from a number of cardiovascular diseases, including heart failure.
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Affiliation(s)
- Elijah Sanches
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marieke Timmermans
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Alper Celik
- Department of Bariatric and Metabolic Surgery, Metabolic Surgery Clinic, Sisli, Turkey
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
| | - Monika Proczko
- Department of General, Endocrine and Transplant Surgery, University Medical Center, Gdansk University, Gdansk, Poland
| | - Pieter S Stepaniak
- Department of Operating Rooms, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
| | - Marc P Buise
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Aleksandr Neimark
- Department of Surgery, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Rich Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.,Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, USA
| | - Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
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32
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Jaiswal A, Truby LK, Chichra A, Jain R, Myers L, Patel N, Topkara VK. Impact of Obesity on Ventricular Assist Device Outcomes. J Card Fail 2019; 26:287-297. [PMID: 31618696 DOI: 10.1016/j.cardfail.2019.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 09/10/2019] [Accepted: 10/08/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity remains a relative contraindication for heart transplantation, and hence, obese patients with advanced heart failure receive ventricular assist devices (VADs) either as a destination or "bridge to weight loss" strategy. However, impact of obesity on clinical outcomes after VAD implantation is largely unknown. We sought to determine the clinical outcomes of obese patients with body mass index (BMI) ≥ 35 kg/m2) following contemporary VAD implantation. METHODS The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry was queried for patients who underwent VAD implantation. Patients were categorized into BMI groups based on World Health Organization classification. RESULTS Of 17,095 patients, 2620 (15%) had a BMI ≥ 35 kg/m2. Obese patients were likely to be young, non-white, females with dilated cardiomyopathy and undergo device implantation as destination. Survival was similar amongst BMI groups (P = .058). Obese patients had significantly higher risk for infection (hazard ratio [HR]: 1.215; P = .001), device malfunction or thrombosis (HR: 1.323; P ≤ .001), cardiac arrhythmia (HR: 1.188; P = .001) and hospital readmissions (HR: 1.073; P = .022), but lower risk of bleeding (HR: 0.906; P = .018). Significant weight loss (≥10%) during VAD support was achieved only by a small proportion (18.6%) of patients with BMI ≥ 35 kg/m2. Significant weight loss rates observed in obese patients with VAD implantation as destination and bridge to transplant strategy were comparable. Obese patients with significant weight loss were more likely to undergo cardiac transplantation. Weight loss worsened bleeding risk without altering risk for infection, cardiac arrhythmia, and device complications. CONCLUSIONS Obesity alone should not be considered a contraindication for VAD therapy in contemporary era. Given durability of heart transplantation, strategies should be developed to promote weight loss, which occurs infrequently in obese patients. Impact of weight loss on clinical outcome of obese patients warrants further investigation.
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Affiliation(s)
- Abhishek Jaiswal
- Hartford HealthCare Heart and Vascular Institute, Hartford, Connecticut.
| | - Lauren K Truby
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Astha Chichra
- Division of Pulmonary and Critical Care, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rashmi Jain
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Leann Myers
- Department of Global Biostatistics and Data Science, Tulane School of Public Health, New Orleans, Louisiana
| | - Nirav Patel
- Hartford HealthCare Heart and Vascular Institute, Hartford, Connecticut
| | - Veli K Topkara
- Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York
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33
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Zenilman A, Pechman D, Moran-Atkin E, Choi J, Camacho D. Bariatric surgery in patients with left ventricular assist devices: a safe and effective method of weight loss as a gateway to heart transplantation. Surg Obes Relat Dis 2019; 15:1780-1784. [DOI: 10.1016/j.soard.2019.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/09/2019] [Accepted: 08/03/2019] [Indexed: 01/11/2023]
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34
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Albert CL. Morbid Obesity as a Therapeutic Target for Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:52. [DOI: 10.1007/s11936-019-0754-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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35
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Pouwels S, Topal B, Knook MT, Celik A, Sundbom M, Ribeiro R, Parmar C, Ugale S. Interaction of obesity and atrial fibrillation: an overview of pathophysiology and clinical management. Expert Rev Cardiovasc Ther 2019; 17:209-223. [PMID: 30757925 DOI: 10.1080/14779072.2019.1581064] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Sjaak Pouwels
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Amsterdam, The Netherlands
| | - Mireille T. Knook
- Department of Surgery, Haaglanden Medical Center, The Hague, The Netherlands
- Nederlandse Obesitas Kliniek West, The Hague, The Netherlands
| | | | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Rui Ribeiro
- Centro Multidisciplinar da Doença Metabólica, Clínica de Santo António, Lisbon, Portugal
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | - Surendra Ugale
- Bariatric & Metabolic Surgery Clinic, Kirloskar Hospital, Hyderabad, India
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36
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Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device. Obes Surg 2019; 29:1122-1129. [DOI: 10.1007/s11695-018-3570-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Berger S, Meyre P, Blum S, Aeschbacher S, Ruegg M, Briel M, Conen D. Bariatric surgery among patients with heart failure: a systematic review and meta-analysis. Open Heart 2018; 5:e000910. [PMID: 30613414 PMCID: PMC6307626 DOI: 10.1136/openhrt-2018-000910] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/22/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Bariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF. Methods We performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery. Results We found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively. Conclusion In this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF.
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Affiliation(s)
- Sebastian Berger
- Cardiology Division, Department of Medicine, University Hospital of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Pascal Meyre
- Cardiology Division, Department of Medicine, University Hospital of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Steffen Blum
- Cardiology Division, Department of Medicine, University Hospital of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Stefanie Aeschbacher
- Cardiology Division, Department of Medicine, University Hospital of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Marco Ruegg
- Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital of Basel, University of Basel, Basel, Switzerland.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Conen
- Cardiology Division, Department of Medicine, University Hospital of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital of Basel, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Lascaris B, Pouwels S, Houthuizen P, Dekker LR, Nienhuijs SW, Bouwman RA, Buise MP. Cardiac structure and function before and after bariatric surgery: a clinical overview. Clin Obes 2018; 8:434-443. [PMID: 30208261 DOI: 10.1111/cob.12278] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/23/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
Obesity, defined as a body mass index of ≥30 kg/m2 , is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity has deleterious effects on cardiac function. The purpose of this review is to evaluate the effects of obesity and excessive weight loss due to bariatric surgery on cardiac function, structural changes and haemodynamic responses of both the left and right ventricle.
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Affiliation(s)
- B Lascaris
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - S Pouwels
- Department of Epidemiology, CAPHRI Research School, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - P Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - L R Dekker
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - S W Nienhuijs
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - R A Bouwman
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - M P Buise
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
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39
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Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant. Surg Obes Relat Dis 2018; 14:1269-1273. [DOI: 10.1016/j.soard.2018.04.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/06/2023]
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40
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Comment on: Laparoscopic sleeve gastrectomy in patients with heart failure and left ventricular assist devices as a bridge to transplant. Surg Obes Relat Dis 2018; 14:1274-1275. [PMID: 29983363 DOI: 10.1016/j.soard.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022]
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41
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English WJ, Williams DB. Metabolic and Bariatric Surgery: An Effective Treatment Option for Obesity and Cardiovascular Disease. Prog Cardiovasc Dis 2018; 61:253-269. [PMID: 29953878 DOI: 10.1016/j.pcad.2018.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/07/2023]
Abstract
Obesity is a chronic and debilitating disease that has become a global epidemic. Especially severe in the Unites States, obesity currently affects almost 40% of the population. Obesity has a strong causal relationship with numerous serious comorbidities that impair quality of life, shorten life expectancy, and carry a major economic burden. Obesity has particular relevance to cardiologists because it contributes directly to several major cardiovascular diseases and, consequently, increases overall cardiovascular mortality. Multiple treatment options are available, but metabolic and bariatric surgery offers the most effective and durable treatment for obesity. Moreover, metabolic and bariatric operations alleviate and often completely eliminate numerous comorbidities, particularly type 2 diabetes and other cardiovascular risk factors, such as hypertension and dyslipidemia. With their low risk of complications and morbidity, metabolic and bariatric operations significantly improve quality of life and overall survival, particularly reducing death due to cardiovascular disease.
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Affiliation(s)
- Wayne J English
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
| | - D Brandon Williams
- Vanderbilt University Medical Center, 1161 21(st) Avenue South, Room D5203 MCN, Nashville, TN 37232-2577, United States of America.
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42
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Greene J, Tran T, Shope T. Sleeve Gastrectomy and Left Ventricular Assist Device for Heart Transplant. JSLS 2018; 21:JSLS.2017.00049. [PMID: 28951657 PMCID: PMC5610117 DOI: 10.4293/jsls.2017.00049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is a severe obesity-related comorbidity. Many patients with end-stage HF eventually require cardiac transplantation for long-term survival. These patients may be precluded from enrollment in heart transplant programs secondary to morbid obesity. We propose a pathway involving sleeve gastrectomy (SG) for patients with morbid obesity and HF to afford cardiac transplantation eligibility. METHODS Three patients with HF and morbid obesity underwent implantation of a left ventricular assist device (LVAD) and SG at an academic tertiary care institution in Washington, DC. This retrospective review from April 2012 through January 2017 examines the perioperative course of these 3 patients with regard to bariatric and cardiac indices, including ejection fraction (EF), HF classification, comorbid diseases, and percentages of total weight loss (%TWL) and excess weight loss (%EWL). RESULTS All three patients underwent LVAD placement as a bridge to transplant but were excluded from cardiac transplantation secondary to body mass index (BMI) and were referred for bariatric surgery. All have demonstrated considerable weight loss, with average decrease in BMI of 19 points, 39% TWL, and 81% EWL at a mean of 44 months after SG. Two patients have gone on to receive heart transplants, with near normalization of their EF. CONCLUSION LVAD and SG constitute a feasible pathway to cardiac transplantation in morbidly obese patients with end-stage HF. LVAD permits temporary cardiac support, whereas SG assists in efficacious weight loss. We explore SG as a durable weight loss option in patients with HF, with LVAD to improve eligibility for orthotopic cardiac transplantation.
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Affiliation(s)
| | - Tung Tran
- Section of Advanced Laparoscopic and Bariatric Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Timothy Shope
- Section of Advanced Laparoscopic and Bariatric Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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43
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Carandina S, Genser L, Bossi M, Montana L, Cortes A, Seman M, Danan M, Barrat C. Laparoscopic Sleeve Gastrectomy in Kidney Transplant Candidates: a Case Series. Obes Surg 2018; 27:2613-2618. [PMID: 28405876 DOI: 10.1007/s11695-017-2679-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with a body mass index (BMI) >35 kg/m2 who need kidney transplant present with increased postoperative mortality and reduced kidney graft survival compared to patients with a lower BMI. For this reason, obese patients are often excluded from the transplantation waiting list. The aim of this study was to evaluate the feasibility and the results of laparoscopic sleeve gastrectomy (LSG) for obese patients awaiting a kidney transplant. METHODS This was a retrospective study on patients with dialysis-dependent renal failure (DDRF) operated on at two first-level bariatric centers in Paris (France). All the patients were contraindicated for kidney transplantation due to the presence of morbid obesity. RESULTS Nine DDFR patients with a mean BMI of 45.9 kg/m2 underwent LSG for the treatment of obesity. Furthermore, all patients presented with hypertension and sleep apnea and six out nine were diabetics. In the immediate postoperative period, all patients were transferred to the intensive care unit (mean stay of 2.1 days). The only major adverse event was a delayed weaning from mechanical ventilation in one patient. The mean hospital stay was 5.5 days (3-12). The total weight loss (TWL) was 27.1, 33.6, and 39.5 kg at 6, 12, and 18 months, respectively. One patient underwent renal transplantation 18 months after LSG, and the other five patients were actively listed for kidney transplantation. CONCLUSIONS According to the results of this small sample series, LSG seems to be an effective and safe procedure in DDRF patients with concomitant obesity and can increase access to transplantation.
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Affiliation(s)
- Sergio Carandina
- Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, route de Stalingrad, Bobigny, France. .,Department of Digestive and Bariatric Surgery, Clinique Saint Michel, 4, Place du 4 Septembre, 83100, Toulon, France.
| | - Laurent Genser
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Pierre & Marie Curie University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Manuela Bossi
- Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, route de Stalingrad, Bobigny, France
| | - Laura Montana
- Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, route de Stalingrad, Bobigny, France
| | - Alexandre Cortes
- Department of Digestive and Metabolic Surgery, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Marne-la-Vallée, 77600, Jossigny, France
| | - Marie Seman
- Department of Digestive and Metabolic Surgery, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Marne-la-Vallée, 77600, Jossigny, France
| | - Marc Danan
- Department of Digestive and Bariatric Surgery, Clinique Saint Michel, 4, Place du 4 Septembre, 83100, Toulon, France
| | - Christophe Barrat
- Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Intégré Nord Francilien de la prise en charge de l'Obésité (CINFO), Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, route de Stalingrad, Bobigny, France
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Has the Time Come to Be More Aggressive With Bariatric Surgery in Obese Patients With Chronic Systolic Heart Failure? Curr Heart Fail Rep 2018; 15:171-180. [DOI: 10.1007/s11897-018-0390-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Early Weight Loss Independent Effects of Sleeve Gastrectomy on Diet-Induced Cardiac Dysfunction in Obese, Wistar Rats. Obes Surg 2018; 27:2370-2377. [PMID: 28299572 DOI: 10.1007/s11695-017-2632-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Several reports suggest that bariatric surgery significantly improves cardiac function in patients with obesity cardiomyopathy. The mechanism is unknown but may be due to weight-loss independent factors. We predict that the changes in gastrointestinal anatomy after a rodent model of sleeve gastrectomy (SG) will have weight-loss independent effects on cardiac dysfunction. METHODOLOGY Cardiac dysfunction was induced by feeding a 60% kcal from fat diet to male Wistar rats for 10 weeks. Rats underwent either a SG (n = 12) or pair-fed, PF (n = 8) sham surgery. Echocardiograms were performed pre- and post-operatively at 6 and 13 weeks. Blood samples were obtained at 10 weeks post-operatively for assessment of insulin sensitivity and heart failure. RESULTS Forty-four percent of SG rats had a normal ejection fraction (EF) at 13 weeks ("responders") compared to five SG rats who did not recover EF ("non-responders"). Zero percent of the PF rats normalized EF (p = 0.03). SG responders had a smaller left ventricular internal diameter in systole and end systolic volume with improved systolic function compared to SG non-responders (EF 90.7 ± 1.7 vs. 75.4 ± 3.6%, p = <0.001). At 10 weeks post-operatively, plasma glucose and B-type natriuretic peptide levels were significantly lower in SG rats compared to PF rats. CONCLUSIONS A SG significantly improved systolic function in 44% of rats with diet-induced obesity and cardiac dysfunction. This improvement is related to weight-loss independent effects of the surgery on the entero-cardiac axis. These results offer a novel weight-loss independent, metabolic role for bariatric surgery as a potential treatment modality for obesity-associated cardiac dysfunction.
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Mid-Term Results and Responsiveness Predictors After Two-Step Single-Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. Obes Surg 2017; 27:1302-1308. [PMID: 27914029 DOI: 10.1007/s11695-016-2471-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND In patients with insufficient weight loss after sleeve gastrectomy (SG) or in super obese individuals, among many surgical options available, a single-anastomosis duodeno-ileal bypass (SADI) after SG (SADI-S) could be considered. Due to the limited information available about the use of SADI as a second-step procedure, the objective of this study was to evaluate the mid-term results and responsiveness of SADI after sleeve gastrectomy. METHODS We present prospective data from 30 consecutive patients with a mean BMI of 40.1 kg/m2, a mean excess weight of 44.7 kg, and a mean excess weight loss (EWL) of 37.5%, who were submitted to a SADI as a second-step revisional procedure. RESULTS There were no intraoperative complications. Four early complications (13.34%) occurred within the first 24 postoperative hours. Six, 12, and 24-month follow-up number of patients available was 30 (100%), 22 (73.3%), and 16 (53.34%), respectively. Percent total weight loss (%WL) was 28.1 at the time of revision and 46.26% 24 months after SADI. Global %EWL was 78.93 ± 35.5. The complete remission rate after SG was 50% for diabetes, 33.3% for dyslipidemia, and 25% for hypertension, and 71.4%, 31.2%, and 27.7%, respectively, after SADI. Three (10%) patients required revisional surgery due to hypoalbuminemia. CONCLUSIONS SADI as a second-step strategy in super obese patients or after failed SG offers a more than satisfactory ponderal weight loss and an acceptable comorbidities resolution. However, the risk of severe malnutrition after distal SADI-S makes necessary a careful patient selection.
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Kindel TL, Strande JL. Bariatric surgery as a treatment for heart failure: review of the literature and potential mechanisms. Surg Obes Relat Dis 2017; 14:117-122. [PMID: 29108893 DOI: 10.1016/j.soard.2017.09.534] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/02/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023]
Abstract
Heart failure due to severe obesity is a complex disease due to multiple mechanisms, including increased body mass, inflammation, and impaired cardiac metabolism that is complicated by obesity-associated co-morbidities, such as type 2 diabetes and obstructive sleep apnea. Bariatric surgery significantly improves cardiac geometry, function, and symptoms related to obesity cardiomyopathy. There is a consistently positive impact of bariatric surgery on diastolic function with the potential to significantly improve systolic function as measured by ejection fraction in patients with advanced heart failure. For end-stage heart failure patients, including those requiring mechanical circulatory support who are ineligible for organ transplant due to morbid obesity, bariatric surgery has been successfully used for weight loss as a bridge to cardiac transplantation.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jennifer L Strande
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Gazzetta P, Bissolati M, Saibene A, Ghidini C, Guarneri G, Giannone F, Adamenko O, Secchi A, Rosati R, Socci C. Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center. Transplant Proc 2017; 49:646-649. [DOI: 10.1016/j.transproceed.2017.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Parto P, Lavie CJ, Arena R, Bond S, Popovic D, Ventura HO. Body habitus in heart failure: understanding the mechanisms and clinical significance of the obesity paradox. Future Cardiol 2016; 12:639-653. [DOI: 10.2217/fca-2016-0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The prevalence of obesity among adults and children worldwide has reached epic proportions and has become a major independent risk factor for the development of heart failure (HF), in addition to a contributor of hypertension and cardiovascular disease. The implications of obesity in the development of HF involve adverse effects on cardiac structure and function. Despite all of this, in the setting of chronic HF, excess body mass is associated with improved clinical outcomes, demonstrating the presence of an obesity paradox. In this review, we will discuss the gender differences, global application, potential mechanisms and role of interventions based on fitness and purposeful weight loss as potential therapeutic strategies.
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Affiliation(s)
- Parham Parto
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Ross Arena
- Department of Physical Therapy, Department of Kinesiology & Nutrition & Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Samantha Bond
- Department of Biomedical & Health Information Sciences, College of Applied Science, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Dejana Popovic
- Clinic for Cardiology, University Clinical Center Serbia, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity. Surg Clin North Am 2016; 96:743-62. [DOI: 10.1016/j.suc.2016.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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