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Bariatric Surgery for Congestive Heart Failure Patients Improves Access to Transplantation and Long-term Survival

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Obese patients with congestive heart failure (CHF) are often denied access to heart transplantation until they obtain significant weight loss to achieve a certain BMI threshold, often less than 35 kg/m2. It is unknown whether the rapid weight loss associated with bariatric surgery leads to improved waitlist placement, and as such improved survival for morbidly obese patients with CHF.

Methods

A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with CHF who were deemed ineligible to be waitlisted for heart transplantation unless they achieved a BMI less than 35 kg/m2. Life expectancy following medical weight management (MWM), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) was estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review.

Results

RYGB improved survival compared with both SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 2.1 additional years of life compared with patient’s who underwent SG and 7.4 additional years of life compared with MWM. SG patients gained 5.3 years of life compared with MWM.

Conclusions

When strict waitlist criteria were applied, bariatric surgery improved access to heart transplantation and thereby increased long-term survival compared with MWM. Morbidly obese CHF patients who anticipate need for heart transplantation should be encouraged to pursue surgical weight management strategies, necessitating discussion between bariatric surgeons, cardiologists, and cardiac surgeons for appropriate perioperative risk management.

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Authors and Affiliations

  1. Department of Surgery- Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, USA

    Rashikh A. Choudhury, H. B. Moore, H. Yaffe, D. Yoeli, K. Prins, K. D. Conzen, J. J. Pomposelli, E. A. Pomfret & T. L. Nydam

  2. Denver, USA

    Rashikh A. Choudhury

  3. Department of Medicine- Division of Cardiovascular Medicine, University of Pennsylvania Hospital, Philadelphia, PA, USA

    M. Foster & J. E. Rame

  4. Department of General Surgery, Jefferson University Hospital, Philadelphia, PA, USA

    G. Hoeltzel

  5. Department of Surgery- Division of Cardiothoracic Surgery, University of Colorado Hospital, Aurora, CO, USA

    C. Ghincea & N. Vigneshwar

  6. Department of Surgery, University of Pennsylvania Hospital, Philadelphia, PA, USA

    K. R. Dumon

Authors
  1. Rashikh A. Choudhury
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  2. M. Foster
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  3. G. Hoeltzel
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  4. H. B. Moore
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  5. H. Yaffe
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  6. D. Yoeli
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  7. K. Prins
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  8. C. Ghincea
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  9. N. Vigneshwar
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  10. K. R. Dumon
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  11. J. E. Rame
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  12. K. D. Conzen
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  13. J. J. Pomposelli
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  14. E. A. Pomfret
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  15. T. L. Nydam
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Contributions

Co-authors involved with each segment of manuscript listed below each requirement. All co-authors listed contributed/agree to below requirements:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: RA Choudhury MD*, M Foster MD**, G Hoeltzel BS***, HB Moore MD PhD*, H Yaffe MD*, D Yoeli MD*, K Prins MD*, C Ghincea MD****, N Vigneshwar MD****, KR Dumon MD*****, JE Rame MD, MPhil**, KD Conzen MD*, JJ Pomposelli MD, PhD*, EA Pomfret MD, PhD*, and TL Nydam MD*

- Drafting the work or revising it critically for important intellectual content: RA Choudhury MD*, M Foster MD**, G Hoeltzel BS***, HB Moore MD PhD*, H Yaffe MD*, D Yoeli MD*, K Prins MD*, C Ghincea MD****, N Vigneshwar MD****, KR Dumon MD*****, JE Rame MD, MPhil**, KD Conzen MD*, JJ Pomposelli MD, PhD*, EA Pomfret MD, PhD*, and TL Nydam MD*

- Final approval of the version to be published: RA Choudhury MD*, M Foster MD**, G Hoeltzel BS***, HB Moore MD PhD*, H Yaffe MD*, D Yoeli MD*, K Prins MD*, C Ghincea MD****, N Vigneshwar MD****, KR Dumon MD*****, JE Rame MD, MPhil**, KD Conzen MD*, JJ Pomposelli MD, PhD*, EA Pomfret MD, PhD*, and TL Nydam MD*

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: RA Choudhury MD*, M Foster MD**, G Hoeltzel BS***, HB Moore MD PhD*, H Yaffe MD*, D Yoeli MD*, K Prins MD*, C Ghincea MD****, N Vigneshwar MD****, KR Dumon MD*****, JE Rame MD, MPhil**, KD Conzen MD*, JJ Pomposelli MD, PhD*, EA Pomfret MD, PhD*, and TL Nydam MD*

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Choudhury, R.A., Foster, M., Hoeltzel, G. et al. Bariatric Surgery for Congestive Heart Failure Patients Improves Access to Transplantation and Long-term Survival. J Gastrointest Surg 25, 926–931 (2021). https://doi.org/10.1007/s11605-020-04587-6

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  • DOI: https://doi.org/10.1007/s11605-020-04587-6

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