Bariatric surgery among patients with heart failure: a systematic review and meta-analysis

Abstract

BackgroundBariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF.MethodsWe performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery.ResultsWe found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively.ConclusionIn this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF.

Impact of bariatric surgery on cardiovascular outcomes and mortality: a population-based cohort study

“…Consistent with the reduction in incident hypertension in the present study, bariatric surgery was also associated with a significant reduction in the risk of HF compared with the control group. A systematic review summarizing the impact of bariatric surgery using data from seven studies found a reduction in incident HF in patients who had bariatric surgery, similar to the present study.…”

The Influence of Surgical Weight Reduction on Left Atrial Strain

“…During our data analysis, we performed a routine indexation to BSA, and we found that BSA indexation introduced a paradoxical increase in LA and LV dimensions after surgery. We think that this finding is of no clinical significance, considering the clinical observations of reduced incidence of atrial fibrillation and heart failure after surgically induced weight loss [20][21][22][23][24]. We believe that these findings reflect well-known difficulties in cardiac chamber indexation in severe obesity [48].…”

“…Data from the literature suggests that the risk of atrial arrhythmia and HFpEF is increased in obesity and with the presence of LA mechanical dysfunction measured by strain. On the other hand, the increased risk of AF and HFpEF in obesity is effectively reduced by surgically induced weight loss [20][21][22][23][24].…”

Metabolic surgery: A clinical update

“…There are no RCTs evaluating cardiovascular outcomes between metabolic surgery and conventional treatment for obesity. However, data suggest that the incidence of heart failure is lower after metabolic surgery 88 . Propensity‐matched cohort studies have found a risk reduction of incident heart failure by 62% and a 50% lower risk in all‐cause mortality in hospitalized patients with heart failure in patients with prior metabolic surgery 78,89 .…”