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Bariatric Surgery in Patients with Severe Heart Failure

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Abstract

Purpose

Obesity and cardiac failure are globally endemic and increasingly intersecting. Bariatric surgery may improve cardiac function and act as a bridge-to-transplantation. We aim to identify effects of bariatric surgery on severe heart failure patients and ascertain its role regarding cardiac transplantation.

Materials and Methods

A retrospective study of a prospectively collected database identified heart failure patients who underwent bariatric surgery between 1 January 2008 and 31 December 2017. Patients were followed up 12 months post-operatively. Cardiac investigations, functional capacity, cardiac transplant candidacy, morbidity and length of stay were recorded.

Results

Twenty-one patients (15 males, 6 females), mean age 48.7 ± 10, BMI 46.2 kg/m2 (37.7–85.3) underwent surgery (gastric band (18), sleeve gastrectomy (2), biliopancreatic diversion (1)). There were no loss to follow-up. There was significant weight loss of 26.0 kg (5.0–78.5, p < 0.001), significant improvement of left ventricular ejection fraction (LVEF) (10.0 ± 11.9%, p < 0.001) and significant reduction of 0.5 New York Heart Association (NYHA) classification (0–2, p < 0.001). Multivariate models delineated the absence of atrial fibrillation and pre-operative BMI < 49 kg/m2 as significant predictors (adjusted R-square 69%) for improvement of LVEF. Mean length of stay was 3.6 days and in-hospital morbidity rate was 42.9%. One patient subsequently underwent a heart transplant, and two patients were removed from the waitlist due to clinical improvements.

Conclusion

Bariatric surgery is safe and highly effective in obese patients with severe heart failure with substantial improvements in cardiac function and symptoms. A threshold pre-operative BMI of 49 kg/m2 and absence of atrial fibrillation may be significant predictors for improvement in cardiac function. There is a role for bariatric surgery to act as a bridge-to-transplantation or even ameliorate this requirement.

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Author information

Authors and Affiliations

  1. Oesophagogastric Bariatric Surgery Unit, The Alfred, Melbourne, Australia

    Tze Wei Wilson Yang, Yazmin Johari, Paul R Burton, Kalai Shaw & Wendy A Brown

  2. Department of Surgery, Monash University, Melbourne, Australia

    Tze Wei Wilson Yang, Yazmin Johari, Paul R Burton, Kalai Shaw & Wendy A Brown

  3. Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia

    Arul Earnest

  4. Department of Cardiology, The Alfred, Melbourne, Australia

    James L Hare

Authors
  1. Tze Wei Wilson Yang
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  2. Yazmin Johari
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  3. Paul R Burton
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  4. Arul Earnest
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  5. Kalai Shaw
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  7. Wendy A Brown
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Corresponding author

Correspondence to Tze Wei Wilson Yang.

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Conflict of Interest

Professor Brown received grants from Johnson and Johnson, grants from Medtronic, grants from GORE, personal fees from GORE, grants from Applied Medical, grants from Apollo Endosurgery, grants and personal fees from Novo Nordisc and personal fees from Merck Sharpe and Dohme, outside the submitted work. The rest of the authors declare that they have no conflict of interest.

Ethical Approval

The Alfred Health Ethics Committee approved the prospective collection of data from the Upper Gastrointestinal and General Surgery database (Project ref. no. 544/18).

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.

For this type of study, formal consent is not required.

Informed consent does not apply.

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Yang, T.W.W., Johari, Y., Burton, P.R. et al. Bariatric Surgery in Patients with Severe Heart Failure. OBES SURG 30, 2863–2869 (2020). https://doi.org/10.1007/s11695-020-04612-2

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  • DOI: https://doi.org/10.1007/s11695-020-04612-2

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