title: Evaluation and treatment of patients with cardiac disease undergoing bariatric surgery.
abstract: BACKGROUND
  Bariatric surgery is a proven tool in reducing the co-morbidities associated with morbid obesity. The aim of the present review was to assess the current data and discuss the strategies for preoperative evaluation, preoperative treatment, and intraoperative management of the obese patient with cardiac disease seeking bariatric surgery, including those who have undergone previous angiographic intervention with coronary stenting and/or antiplatelet therapy. The setting was a university hospital in the United States.
  
  
  METHODS
  A search of the English-language reports using the keywords morbid obesity, bariatric surgery, perioperative risk assessment, coronary artery disease, coronary stents, and antiplatelet therapy was conducted.
  
  
  RESULTS
  The methods of preoperative cardiac risk assessment found in the published studies included the use of certain criteria, stress echocardiography, and single-photon emission computed tomography. Preoperative medical treatment optimization with β-blockers and statins is recommended. Perioperative antiplatelet therapy in the form of aspirin 81 mg can be safely continued, but clopidogrel should be stopped and reinitiated with caution.
  
  
  CONCLUSIONS
  Preoperative assessment of morbidly obese patients with coexisting cardiac issues presents unique challenges. Safe patient care and good clinical outcomes can be achieved with adherence to evidence-based practice.
authors.affiliation: Division of General and Laparoscopic Surgery, Department of Surgery, University of Southern California, Los Angeles, California 90033, USA. nkatkhouda@surgery.usc.edu
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason
authors.forename: Bob
authors.initials: B
authors.lastname: Wu
authors.forename: Fayez S
authors.initials: FS
authors.lastname: Takla
authors.forename: Rory M
authors.initials: RM
authors.lastname: Keenan
authors.forename: Joerg
authors.initials: J
authors.lastname: Zehetner
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods; D050110:Bariatric Surgery / Q000379:methods*; D000075202:Contraindications; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis; D025401:Echocardiography, Stress; D019983:Guideline Adherence; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D010975:Platelet Aggregation Inhibitors; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D015607:Stents; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors