title: Bariatric Surgery Provides a "Bridge to Transplant" for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation.
abstract: BACKGROUND
  In patients with advanced heart failure, morbid obesity is a relative contraindication to heart transplantation due to higher morbidity and mortality in these patients.
  
  
  METHODS
  We performed a retrospective analysis of consecutive morbidly obese patients with advanced heart failure who underwent bariatric surgery for durable weight loss in order to meet eligibility criteria for cardiac transplantation.
  
  
  RESULTS
  Seven patients (4 M/3 F, age range 31-56 years) with left ventricular ejection fraction (LVEF) ≤ 25 % underwent laparoscopic bariatric surgery. Median preoperative body mass index (BMI) was 42.8 kg/m(2) (range 37.5-50.8). There were no major perioperative complications in six of seven patients. Median length of hospital stay was 5 days. There was no mortality recorded during complete patient follow-up. At a median follow-up of 406 days, median BMI reduction was 12.9 kg/m(2) (p = 0.017). Postoperative LVEF improved to a median of 30 % (interquartile range (IQR) 25-53 %; p = 0.039). Two patients underwent successful cardiac transplantation. Two patients reported symptomatic improvement with little change in LV function and now successfully meet listing criteria. Three patients showed marked improvement of their LVEF and functional status, thus removing the requirement for transplantation.
  
  
  CONCLUSIONS
  Bariatric surgery can achieve successful weight loss in morbidly obese patients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.
authors.affiliation: Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia.|Cardiology Department, National Heart Centre Singapore, Singapore, Singapore.
authors.forename: Choon-Pin
authors.initials: CP
authors.lastname: Lim
authors.affiliation: St Vincent's Centre for Applied Medical Research, Sydney, Australia.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Fisher
authors.affiliation: St Vincent's Centre for Applied Medical Research, Sydney, Australia.|Department of Surgery, Lund University and Lund University Hospital (SUS Skane), 221 85, Lund, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Falkenback
authors.affiliation: Department of Anesthetics, St Vincent's Hospital, Sydney, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Boyd
authors.affiliation: Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hayward
authors.affiliation: Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Keogh
authors.affiliation: Department of Endocrinology, St Vincent's Hospital, Sydney, Australia.|Diabetes and Obesity Program, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Katherine
authors.initials: K
authors.lastname: Samaras
authors.affiliation: Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: MacDonald
authors.affiliation: St Vincent's Centre for Applied Medical Research, Sydney, Australia. rvlord@stvincents.com.au.|Department of Surgery, University of Notre Dame, School of Medicine, St. Vincent's Hospital, Sydney, Australia. rvlord@stvincents.com.au.
authors.forename: Reginald V
authors.initials: RV
authors.lastname: Lord
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Bariatric surgery; Congestive heart failure; Obesity