Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy.
BACKGROUND
Longstanding morbid obesity can be associated with severe cardiomyopathy. However, the safety and efficacy of bariatric surgery in patients with severe cardiomyopathy has not been studied, and the effect of surgical weight loss on postoperative cardiac function is also unknown. In addition, morbidly obese patients have significantly increased mortality associated with cardiac transplantation, often precluding them from becoming recipients.


METHODS
A retrospective study of patients with a left ventricular ejection fraction < or =35% who underwent bariatric surgery (1998-2005) was performed. Short-term morbidity/mortality, length of stay, excess weight loss, pre- and postoperative left ventricular ejection fraction, and New York Heart Association (NYHA) functional class were assessed.


RESULTS
A total of 14 patients (10 men and 4 women) with a mean preoperative body mass index of 50.8 +/- 2.04 kg/m(2) underwent bariatric surgery (10 underwent laparoscopic Roux-en-Y gastric bypass, 1 open Roux-en-Y gastric bypass, 2 sleeve gastrectomy, and 1 laparoscopic gastric banding). The complications were pulmonary edema in 1, hypotension in 1, and transient renal insufficiency in 2. The median length of stay was 3.0 days (range 2-9). The mean excess weight loss at 6 months was 50.4%, with a decrease in the mean body mass index from 50.8 +/- 2.04 kg/m(2) to 36.8 +/- 1.72 kg/m(2). The mean left ventricular ejection fraction at 6 months had significantly improved from 23% +/- 2% to 32% +/- 4% (P = .04), correlating with improved functional capacity, as measured by the NYHA classification. Preoperatively, 2 patients (14%) had an NYHA classification of IV, 6 (43%) a classification of III, and 6 (43%) a classification of II. At 6 months postoperatively, no patient had an NYHA classification of IV, 2 (14%) had a classification of III, and 12 (86%) an NYHA classification of II. Two patients had undergone cardiac transplant evaluations preoperatively and underwent successful transplantation after weight loss.


CONCLUSIONS
The results of our study have shown that bariatric surgery for patients with cardiomyopathy is feasible and effective. Surgically induced weight loss results in both subjective and objective improvement in cardiac function. In addition, surgical weight loss can provide a bridge to transplantation in patients who were prohibited secondary to their morbid obesity.
McCloskey
C A
CA
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15227, USA. mccloskeyc@upmc.edu
Ramani
G V
GV
Mathier
M A
MA
Schauer
P R
PR
Eid
G M
GM
Mattar
S G
SG
Courcoulas
A P
AP
Ramanathan
R
R
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D050110:Bariatric Surgery / Q000009:adverse effects; D015992:Body Mass Index; D009202:Cardiomyopathies / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D015390:Gastric Bypass; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D011654:Pulmonary Edema / Q000209:etiology; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D015431:Weight Loss