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Obesity Surgery

, Volume 26, Issue 3, pp 486–493 | Cite as

Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

  • Choon-Pin Lim
  • Oliver M. Fisher
  • Dan Falkenback
  • Damien Boyd
  • Christopher S. Hayward
  • Anne Keogh
  • Katherine Samaras
  • Peter MacDonald
  • Reginald V. LordEmail author
Original Contributions

Abstract

Background

In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.

Methods

We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.

Results

Seven patients (4 M/3 F, age range 31–56 years) with left ventricular ejection fraction (LVEF) ≤25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m2 (range 37.5–50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m2 (p = 0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25–53 %; p = 0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.

Conclusions

Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.

Keywords

Bariatric surgery Congestive heart failure Obesity 

Notes

Conflict of Interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Funding

OMF is supported by the Swiss Cancer League (BIL KLS-3133-02-2013). DF is supported by the Swedish Society of Medicine, the Maggie Stephens Foundation, and the Sparre Foundation. RVL is supported by a NHMRC Centre of Research Excellence grant. The funders had no role in study design, date collection and analysis, decision to publish, or preparation of the manuscript.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Choon-Pin Lim
    • 1
    • 2
  • Oliver M. Fisher
    • 3
  • Dan Falkenback
    • 3
    • 4
  • Damien Boyd
    • 5
  • Christopher S. Hayward
    • 1
  • Anne Keogh
    • 1
  • Katherine Samaras
    • 6
    • 7
  • Peter MacDonald
    • 1
  • Reginald V. Lord
    • 3
    • 8
    Email author
  1. 1.Heart Transplant UnitSt Vincent’s HospitalSydneyAustralia
  2. 2.Cardiology DepartmentNational Heart Centre SingaporeSingaporeSingapore
  3. 3.St Vincent’s Centre for Applied Medical ResearchSydneyAustralia
  4. 4.Department of SurgeryLund University and Lund University Hospital (SUS Skane)LundSweden
  5. 5.Department of AnestheticsSt Vincent’s HospitalSydneyAustralia
  6. 6.Department of EndocrinologySt Vincent’s HospitalSydneyAustralia
  7. 7.Diabetes and Obesity ProgramGarvan Institute of Medical ResearchSydneyAustralia
  8. 8.Department of SurgeryUniversity of Notre Dame, School of Medicine, St. Vincent’s HospitalSydneyAustralia

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