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


OBJECTIVE
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.
Ramani
Gautam V
GV
Cardiovascular Institute, University of Pittsburgh Medical Center Pittsburgh, PA 15213, USA. gvr001@yahoo.com
McCloskey
Carol
C
Ramanathan
Ramesh C
RC
Mathier
Michael A
MA
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D054143:Heart Failure, Systolic / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016277:Ventricular Function, Left