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Safety and efficacy of bariatric surgery in morbidly obese patients with severe systolic heart failure.

AbstractBACKGROUND:
Morbid obesity (MO) is a risk factor for congestive heart failure (CHF). The presence of MO impairs functional status and disqualifies patients for cardiac transplantation. Bariatric surgery (BAS) is a frontline, durable treatment for MO; however, the safety and efficacy of BAS in advanced CHF is unknown.
HYPOTHESIS:
We hypothesized that by utilizing a coordinated approach between an experienced surgical team and heart failure specialists, BAS is safe in patients with advanced systolic CHF and results in favorable outcomes.
METHODS:
We performed a retrospective chart review of 12 patients with MO (body mass index [BMI] 53 +/- 7 kg/m2) and systolic CHF (left ventricular ejection fraction [LVEF] 22 +/- 7%, New York Heart Association [NYHA] class 2.9 +/- 0.7) who underwent BAS, and then compared outcomes with 10 matched controls (BMI 47.2 +/- 3.6 kg/m2, LVEF 24 +/- 7%, and NYHA class 2.4 +/- 0.7) who were given diet and exercise counseling.
RESULTS:
At 1 y, hospital readmission in BAS patients was significantly lower than controls (0.4 +/- 0.8 versus 2.5 +/- 2.6, p = 0.04); LVEF improved significantly in BAS patients (35 +/- 15%, p = 0.005), but not in controls (29 +/- 14%, p = not significant [NS]). The NYHA class improved in BAS patients (2.3 +/- 0.5, p = 0.02), but deteriorated in controls (3.3 +/- 0.9, p = 0.02). One BAS patient was successfully transplanted, and another listed for transplantation.
CONCLUSIONS:
Bariatric surgery is safe and effective in patients with MO and severe systolic CHF, and should be considered in patients who have failed conventional therapy to improve clinical status.
AuthorsGautam V Ramani, Carol McCloskey, Ramesh C Ramanathan, Michael A Mathier
JournalClinical cardiology (Clin Cardiol) Vol. 31 Issue 11 Pg. 516-20 (Nov 2008) ISSN: 0160-9289 [Print] United States
PMID19006115 (Publication Type: Journal Article)
CopyrightCopyright 2008 Wiley Periodicals, Inc.
Topics
  • Adult
  • Bariatric Surgery (adverse effects, methods)
  • Body Mass Index
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Heart Failure (etiology)
  • Heart Failure, Systolic (etiology, physiopathology)
  • Humans
  • Male
  • Middle Aged
  • Obesity, Morbid (complications, physiopathology, surgery)
  • Retrospective Studies
  • Ventricular Function, Left

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