A Population-Based Study of Early Postoperative Outcomes in Patients with Heart Failure Undergoing Bariatric Surgery

Abstract

The NSQIP definition of HF, which includes recent hospitalization for HF exacerbation or new HF diagnosis 30 days prior to surgery, predicts a more than two-fold increase in odds of morbidity following bariatric surgery. This must be balanced with the longer-term potential benefits of weight loss and associated improvement in cardiac function in this population.

Regression of severe heart failure after combined left ventricular assist device placement and sleeve gastrectomy

“…[30][31][32][33] Therefore, it has emerged as the procedure of choice for patients who are at higher risk of developing severe complications as well as those who may need a heart transplant. 34,35 There have been reports of modest Regression of severe heart failure after combined left ventricular assist device placement and sleeve gastrectomy improvement in LVEF after bariatric surgery in patients with HF, which in some cases obviated the need for cardiac transplantation. [10][11][12]15,16 There is, however, to the best of our knowledge, no previous report of LVEF normalization after bariatric surgery in patients with obesity and severe HF requiring LVAD therapy.…”

“…LSG, as a relatively straightforward procedure without intestinal anastomosis, has a safer long‐term risk profile compared with other bariatric procedures such as Roux‐en‐Y gastric bypass or biliopancreatic diversion 30–33 . Therefore, it has emerged as the procedure of choice for patients who are at higher risk of developing severe complications as well as those who may need a heart transplant 34,35 . There have been reports of modest improvement in LVEF after bariatric surgery in patients with HF, which in some cases obviated the need for cardiac transplantation 10–12,15,16 .…”

Safety of Bariatric Surgery in Patients With Congestive Heart Failure: Results of an 11-Year Retrospective Study

“…The majority of studies found that bariatric surgery is safe in patients with cardiac disease and CHF and resulted in positive outcomes. Weight loss after surgery reduces the risk of cardiovascular events 7,[28][29][30][31][32] ; improves symptoms of CHF, decreases LV mass, and improves LV systolic function and diastolic filling 1,2,4-7,9,11, [14][15][16][17]20,21,24,[27][28][29][33][34][35][36][37][38][39] ; and reduces diabetes, hypertension, and hyperlipidemia which can contribute to cardiovascular disease. 18,23,28,29,34,40,41 The results of these studies seem to support the conclusion that bariatric surgery is reasonably safe and effective in obese patients with heart failure, although not without some degree of risk.…”

“…But, patients with heart failure were associated with increased likelihood of length of stay more than 7 days, likelihood to remain ventilated over 48 hours, venous thromboembolism, and reoperation. 27…”

“…But, patients with heart failure were associated with increased likelihood of length of stay more than 7 days, likelihood to remain ventilated over 48 hours, venous thromboembolism, and reoperation. 27 This study is exploratory and observational in nature and mainly had 2 limitations: first, it was based on a small cohort of patients (n = 41), and second, there was no comparison group.…”