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. 2008 Nov 12;31(11):516–520. doi: 10.1002/clc.20315

Safety and Efficacy of Bariatric Surgery in Morbidly Obese Patients with Severe Systolic Heart Failure

Gautam V Ramani 1,✉, Carol McCloskey 2, Ramesh C Ramanathan 2, Michael A Mathier 1
PMCID: PMC6652810  PMID: 19006115

Abstract

Background

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. Copyright © 2008 Wiley Periodicals, Inc.

Keywords: bariatric surgery, morbid obesity, congestive heart failure, metabolic cardiomyopathy

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References

  • 1. Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH: Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 2002; 288: 1758–1761. [DOI] [PubMed] [Google Scholar]
  • 2. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW: Body‐mass index and mortality in a prospective cohort of U.S. Adults. N Engl J Med 1999; 341: 1097–1105. [DOI] [PubMed] [Google Scholar]
  • 3. Wison PW, D'Agostino RB, Sullivan L, Praise H, Kannel WB: Overweight and obesity as determinants of cardiovascular risk: the Framingham experience. Arch Intern Med 2002; 162: 1867–1872. [DOI] [PubMed] [Google Scholar]
  • 4. Alpert MA, Lambert CR, Terry BE, Cohen MV, Mukerji V, et al.: Influence of left ventricular mass on left ventricular diastolic filling in normotensive morbid obesity. Am Heart J 1995; 130: 1068–1073. [DOI] [PubMed] [Google Scholar]
  • 5. Alpert MA, Lambert CR, Panayiotou H, Terry BE, Cohen MV, et al.: Relation of duration of morbid obesity to left ventricular mass, systolic function, diastolic filling, and effect of weight loss. Am J Cardiol 1995; 76: 1194–1197. [DOI] [PubMed] [Google Scholar]
  • 6. Lavie CJ, Osman AF, Milani RV, Mehra MR: Body composition and prognosis in chronic systolic heart failure: The obesity paradox. Am J Cardiol 2003; 99: 891–894. [DOI] [PubMed] [Google Scholar]
  • 7. Gallagher MJ, Franklin BA, Ehrman JK, Keteyian SJ, Brawner CA, et al.: Comparative impact of morbid obesity vs heart failure on cardiorespiratory fintness. Chest 2005; 127: 2197–2203. [DOI] [PubMed] [Google Scholar]
  • 8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Porles W, et al.: Bariatric surgery: a systematic review and meta‐analysis. JAMA 2004; 292: 1724–1737. [DOI] [PubMed] [Google Scholar]
  • 9. Nguyen NT, Root J, Zainabadi K, Sabio A, Chalifoux S, et al.: Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg 2005; 140: 1198–1202. [DOI] [PubMed] [Google Scholar]
  • 10. Poirier P, Martin J, Picard M, Biron S, Marceau S: Impact of bariatric surgery on cardiac structure, function and clinical manifestations in morbid obesity. Expert Rev Cardiovasc Ther 2004; 2: 193–201. [DOI] [PubMed] [Google Scholar]
  • 11. Gould JC, Garren MJ, Boll V, Starling JR: Laparoscopic gastric bypass: risk vs benefits up to two years following surgery in super‐super obese patients. Surgery 2006; 140: 524–529. [DOI] [PubMed] [Google Scholar]
  • 12. Kenchaiah S, Evans J, Levy D, Wilson PW, Benjamin EJ, et al.: Obesity and the risk of heart failure. N Engl J Med 2002; 347: 305–313. [DOI] [PubMed] [Google Scholar]
  • 13. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, et al.: Risk factors for congestive heart failure in the elderly: a prospective community‐based study. Am J Med 1999; 106: 605–612. [DOI] [PubMed] [Google Scholar]
  • 14. Kenchaiah S, Gaziano J, Vasan R: Impact of obesity on the risk of heart failure and survival after the onset of heart failure. Med Clin North Am 2004; 88: 1273–1294. [DOI] [PubMed] [Google Scholar]
  • 15. Ingelsson E, Arnolv J, Sundstrom J, Zethelius B, Vessby B, et al.: Novel metabolic risk factors for heart failure. J Am Coll Cardiol 2005; 46: 2054–2060. [DOI] [PubMed] [Google Scholar]
  • 16. Wang CY, O'moore‐Sullivan T, Leano R, Byrne N, Beller E, et al.: Alterations of left ventricular myocardial characteristics associated with obesity. Circulation 2004; 110: 3081–3087. [DOI] [PubMed] [Google Scholar]
  • 17. Himeno E, Nishino K, Nakashima Y, Kuroiwa A, Ikeda M: Weight reduction regresses left ventricular mass regardless of blood pressure level in obese subjects. Am Heart J 1996; 131: 313–319. [DOI] [PubMed] [Google Scholar]
  • 18. Nguyen NT, Goldman C, Rosenquist CJ, Arango A, Cole CJ, et al.: Laparoscopic versus open bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001; 234: 279–291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Fernstrom JD, Courcoulas AP, Houck PR, Fernstrom MH: Long‐term changes in blood pressure in extremely obese patients who have undergone bariatric surgery. Arch Surg 2006; 141: 276–283. [DOI] [PubMed] [Google Scholar]
  • 20. Ruano M, Silvestre V, Castro R, Garcia‐Lescun MC, Rodriguez A, et al.: Morbid obesity, hypertensive disease and the rennin angiotensin aldosterone axis. Obes Surg 2005; 15: 670–676. [DOI] [PubMed] [Google Scholar]
  • 21. Ramos AP, de Abreu MR, Vendramini RC, Brunetti IL, Pepato MT: Decrease in circulating glucose, insulin and leptin levels and improvement in insulin resistance at 1 and 3 months after gastric bypass. Obes Surg 2006; 16: 1359–1364. [DOI] [PubMed] [Google Scholar]
  • 22. Schuze PC, Kratzsch J, Linke A, Schoene N, Adams V, et al.: Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure. Eur J Heart Fail 2003; 5: 33–40. [DOI] [PubMed] [Google Scholar]
  • 23. Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW, et al.: The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J 2001; 22: 1318–1327. [DOI] [PubMed] [Google Scholar]
  • 24. Taylor DO, Edwards LB, Boucek MM, Trulock EP, Deng MC, et al.: Registry of the International Society for Heart and Lung Transplantation: twenty‐second official adult heart transplant report–2005. J Heart Lung Transplant 2005; 24: 945–955. [DOI] [PubMed] [Google Scholar]

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