Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese Patients

Lee, Yung; Anvari, Sama; Soon, Melissa Sam; Tian, Chenchen; Wong, Jorge; Anvari, Mehran; Doumouras, Aristithes G.

doi:10.1097/crd.0000000000000346

Cited by 13 publications

(7 citation statements)

References 49 publications

(92 reference statements)

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“…Similarly, MBS is shown to be safe and effective as a bridge to liver transplantation in selected patients who would otherwise be ineligible [ 80 , 81 ]. Heart transplant candidacy can also be improved by MBS, and reports in some patients demonstrate significant improvement in left ventricular ejection fraction after surgery to remove the requirement for transplantation [ 82 , 83 ]. MBS has been shown to be safe and effective in patients with heart failure and a left ventricular assist device (LVAD).…”

Section: Bridge To Other Treatmentmentioning

confidence: 99%

“…There are increasing data to suggest that MBS can be a useful adjunct to treatment in patients with obesity and heart failure before heart transplantation or placement of a left ventricular assist device (LVAD), and performed with low morbidity and mortality [ 82 , 84 , 99 ]. The consequent improvement in obesity and associated co-morbidities improves overall health and can reduce the future risk associated with cardiac therapies.…”

Section: Mbs In the High-risk Patientmentioning

confidence: 99%

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2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

Eisenberg

Shikora

Aarts³

et al. 2022

OBES SURG

225

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Major updates to 1991 National Institutes of Health guidelines for bariatric surgeryMetabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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Section: Bridge To Other Treatmentmentioning

confidence: 99%

Section: Mbs In the High-risk Patientmentioning

confidence: 99%

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

Eisenberg

Shikora

Aarts³

et al. 2022

OBES SURG

225

View full text Add to dashboard Cite

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“…The reverse has been reported in patients undergoing bariatric surgery. Weight loss postbariatric surgery was associated with improvement in both ejection fraction and subjective improvement in functional capacity . It is increasingly difficult for patients with end-stage heart failure to lose weight (besides considering bariatric surgery) and experts only recommend 5% to 10% weight loss before considering advanced therapies .…”

Section: Discussionmentioning

confidence: 99%

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

et al. 2023

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ImportancePretransplant obesity and higher pulmonary vascular resistance (PVR) are risk factors for death after heart transplant. However, it remains unclear whether appropriate donor-to-recipient size matching using predicted heart mass (PHM) is associated with lower risk.ObjectiveTo investigate the association of size matching using PHM with risk of death posttransplant among patients with obesity and/or higher PVR.Design, Setting, and ParticipantsAll adult patients (&gt;18 years) who underwent heart transplant between 2003 and 2022 with available information using the United Network for Organ Sharing cohort database. Multivariable Cox models and multivariable-adjusted spline curves were used to examine the risk of death posttransplant with PHM matching. Data were analyzed from October 2022 to March 2023.ExposureRecipient’s body mass index (BMI) in categories (&lt;18.0 [underweight], 18.1-24.9 [normal weight, reference], 25.0-29.9 [overweight], 30.0-34.9 [obese 1], 35-39.9 [obese 2], and ≥40.0 [obese 3]) and recipient’s pretransplant PVR in categories of less than 4 (29 061 participants), 4 to 6 (2842 participants), and more than 6 Wood units (968 participants); and less than 3 (24 950 participants), 3 to 5 (6115 participants), and 5 or more (1806 participants) Wood units.Main OutcomeAll-cause death posttransplant on follow-up.ResultsThe mean (SD) age of the cohort of 37 712 was 52.8 (12.8) years, 27 976 (74%) were male, 25 342 were non-Hispanic White (68.0%), 7664 were Black (20.4%), and 3139 were Hispanic or Latino (8.5%). A total of 12 413 recipients (32.9%) had a normal BMI, 13 849 (36.7%) had overweight, and 10 814 (28.7%) had obesity. On follow-up (median [IQR] 5.05 [0-19.4] years), 12 785 recipients (3046 female) died. For patients with normal weight, overweight, or obese 2, receiving a PHM-undermatched heart was associated with an increased risk of death (normal weight hazard ratio [HR], 1.20; 95% CI, 1.07-1.34; overweight HR, 1.12; 95% CI, 1.02-1.23; and obese 2 HR, 1.07; 95% CI, 1.01-1.14). Moreover, patients with higher pretransplant PVR who received an undermatched heart had a higher risk of death posttransplant in multivariable-adjusted spline curves in graded fashion until appropriately matched. In contrast, risk of death among patients receiving a PHM-overmatched heart did not differ from the appropriately matched group, including in recipients with an elevated pretransplant PVR.Conclusion and RelevanceIn this cohort study, undermatching donor-to-recipient size according to PHM was associated with higher posttransplant mortality, specifically in patients with normal weight, overweight, or class II obesity and in patients with elevated pretransplant PVR. Overmatching donor-to-recipient size was not associated with posttransplant survival.

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“…This concurs with a systematic meta‐analysis of 11 studies with 98 patients that found bariatric surgery as a safe and effective method to achieve heart transplant and weight loss in end‐stage heart failure patients. The optimal method of bariatric surgery and long‐term outcomes are areas of research requiring further investigation 31 . Another future consideration is for centers to utilize BMI as a controlled value in LVAD patients.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal method of bariatric surgery and long-term outcomes are areas of research requiring further investigation. 31 Another future consideration is for centers to utilize BMI as a controlled value in LVAD patients. BMI control could be utilized as a criterion similar to anticoagulation, diabetes, and other conditions that are well controlled for in these patients as part of a bridge to transplant plan.…”

Section: Discussionmentioning

confidence: 99%

Isolated left ventricular assist device implantation produces variable changes to patient body mass index

et al. 2022

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Background Body mass index (BMI) is an important consideration for transplant‐eligible left ventricular assist device (LVAD) recipients. LVAD therapy’s impact on BMI is unclear. We evaluated BMI changes in patients who underwent LVAD implantation. The association between these patients’ BMI and the transplant was studied. Methods This was a retrospective cohort study of patients who underwent LVAD implantation between January 1, 2012 and December 31, 2018 at our institution. Patients were stratified by preoperative BMI (kg/m2) into four groups: <30, 30–34.9, 34.9–39.9, and ≥40. BMI data were collected at 12 and 6 months prior to implantation, time of implantation, and 3‐ and 6‐ months postimplantation. Results A total of 107 patients underwent LVAD implantation at our institution. Data were available for 80 patients. Baseline characteristics included a mean age of 56.0 years, 69% male, and a mean implant BMI of 29.9 ± 6.8 kg/m2. The mean BMI (kg/m2) for each of the BMI (kg/m2) groups <30, 30–34.9, 35–39.9, and ≥40 (n = 60, 25, 12, and 10, respectively) was 25.1, 32.5, 36.8, and 43.8, respectively. There was no consistent pattern with weight change across differing implant BMIs. No patient with a BMI of <30 gained sufficient weight to impact transplant candidacy. Twenty‐three percent of patients with a BMI of 30–34.9 kg/m2, 60% of patients with a BMI of 35–39.9 kg/m2, and 87.5% of patients with a BMI of ≥40 kg/m2 had a 6‐month BMI potentially affecting transplant. Conclusions Associated weight changes during LVAD support may significantly impact transplant candidacy. Higher BMI groups may benefit from multimodal and multidisciplinary targeted weight‐loss interventions.

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Bariatric Surgery as a Bridge to Heart Transplantation in Morbidly Obese Patients

Cited by 13 publications

References 49 publications

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery

Association of Size Matching Using Predicted Heart Mass With Mortality in Heart Transplant Recipients With Obesity or High Pulmonary Vascular Resistance

Isolated left ventricular assist device implantation produces variable changes to patient body mass index

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