Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

Lim, Chae-Young; Fisher, Oliver M.; Falkenback, Dan; Boyd, Damien; Hayward, Christopher; Keogh, Anne; Samaras, Katherine; Macdonald, Peter S.; Lord, Reginald V.

doi:10.1007/s11695-015-1789-1

Cited by 59 publications

(30 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Improvements in Congestive Heart Failure (CHF) symptoms and Assessment of New York Heart Association (NYHA) functional class are observed 6–12 months after surgery , indicating that excessive weight loss has a positive effect on cardiac remodelling. These findings are supported by several case series investigating the effect of bariatric surgery on LVEF in patients with end‐stage heart failure and/or patients scheduled for heart transplantation .…”

Section: After Bariatric Surgerysupporting

confidence: 62%

“…Strictly taken, the guidelines of the IFSO (64) do not consider cardiac pathology solely as an indication for bariatric surgery. In patients with (end-stage) heart failure, several case series have demonstrated the positive effect of weight loss (due to bariatric surgery) on LVEF and the NYHA functional class (of heart failure) (34,38,(60)(61)(62). Ristow et al (65) reported on two patients who no longer required heart transplantation after successful weight reduction and improvement of LVEF.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

See 1 more Smart Citation

Cardiac structure and function before and after bariatric surgery: a clinical overview

et al. 2018

View full text Add to dashboard Cite

Obesity, defined as a body mass index of ≥30 kg/m , is the most common chronic metabolic disease worldwide and its prevalence has been strongly increasing. Obesity has deleterious effects on cardiac function. The purpose of this review is to evaluate the effects of obesity and excessive weight loss due to bariatric surgery on cardiac function, structural changes and haemodynamic responses of both the left and right ventricle.

show abstract

Section: After Bariatric Surgerysupporting

confidence: 62%

Section: Implications For Clinical Practicementioning

confidence: 99%

Cardiac structure and function before and after bariatric surgery: a clinical overview

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Patient series have suggested beneficial effects on cardiac function 7 and prognosis 14 of bariatric surgery in patients with heart failure, but other studies have shown an inverse association of BMI with mortality among people with heart failure. 15, 16 The present study only included people without heart failure at baseline and hence gives no implications for treatment of obese people with heart failure.…”

Section: Discussionmentioning

confidence: 99%

Weight Loss and Heart Failure

et al. 2017

View full text Add to dashboard Cite

Background Associations of obesity with incidence of heart failure have been observed, but the causality is uncertain. We hypothesized that gastric bypass surgery leads to lower incidence of heart failure compared to intensive lifestyle modification in obese people. Methods We included obese people without previous heart failure from a Swedish nationwide registry of people treated with a structured intensive lifestyle program, and the Scandinavian Obesity Surgery Registry. All analyses used inverse probability weights, based on baseline body-mass index and a propensity score estimated using baseline variables. Treatment groups were well balanced regarding weight, body mass index and most potential confounders. Associations of treatment with heart failure incidence, as defined in the National Patient Register, were analyzed using Cox regression. Results The 25,804 gastric bypass surgery patients had on average lost 18.8 kg more weight after 1 year, and 22.6 kg more after 2 years, than the 13,701 lifestyle modification patients. During a median of 4.1 years, surgery patients had lower heart failure incidence than lifestyle modification patients (hazard ratio 0.54, 95% CI 0.36–0.82). A 10 kg achieved weight loss after 1 year was related to a hazard ratio for heart failure of 0.77, 95% confidence interval 0.60 to 0.97, in both treatment groups combined. Results were robust in sensitivity analyses. Conclusions Gastric bypass surgery was associated with approximately one half the incidence of heart failure compared with intensive lifestyle modification in this study of two large nationwide registries. We also observed a graded association between increasing weight loss and decreasing risk of heart failure.

show abstract

Section: Introductionmentioning

confidence: 99%

“…In advanced heart failure patients, bariatric surgery was initially used for weight loss as a bridge to cardiac transplantation [4, 5]. Surprisingly, bariatric surgery significantly improved both symptoms of heart failure and cardiac function in 50% of patients [5–7]. Post-surgical cardiac changes include significant improvements in cardiac geometry and function including decreased hypertrophy and dilation with increased EF and improved relaxation [8].…”

Section: Introductionmentioning

confidence: 99%

Early Weight Loss Independent Effects of Sleeve Gastrectomy on Diet-Induced Cardiac Dysfunction in Obese, Wistar Rats

et al. 2017

View full text Add to dashboard Cite

Introduction Several reports suggest that bariatric surgery significantly improves cardiac function in patients with obesity cardiomyopathy. The mechanism is unknown but may be due to weight-loss independent factors. We predict that the changes in gastrointestinal anatomy after a rodent model of sleeve gastrectomy (SG) will have weight-loss independent effects on cardiac dysfunction. Methodology Cardiac dysfunction was induced by feeding a 60% kcal from fat diet to male Wistar rats for 10 weeks. Rats underwent either a SG (n = 12) or pair-fed, PF (n = 8) sham surgery. Echocardiograms were performed pre- and post-operatively at 6 and 13 weeks. Blood samples were obtained at 10 weeks post-operatively for assessment of insulin sensitivity and heart failure. Results Forty-four percent of SG rats had a normal ejection fraction (EF) at 13 weeks (“responders”) compared to five SG rats who did not recover EF (“non-responders”). Zero percent of the PF rats normalized EF (p = 0.03). SG responders had a smaller left ventricular internal diameter in systole and end systolic volume with improved systolic function compared to SG non-responders (EF 90.7 ± 1.7 vs. 75.4 ± 3.6%, p = <0.001). At 10 weeks post-operatively, plasma glucose and B-type natriuretic peptide levels were significantly lower in SG rats compared to PF rats. Conclusions A SG significantly improved systolic function in 44% of rats with diet-induced obesity and cardiac dysfunction. This improvement is related to weight-loss independent effects of the surgery on the entero-cardiac axis. These results offer a novel weight-loss independent, metabolic role for bariatric surgery as a potential treatment modality for obesity-associated cardiac dysfunction.

show abstract

Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

Abstract: 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.

Cited by 59 publications

References 33 publications

Cardiac structure and function before and after bariatric surgery: a clinical overview

Cardiac structure and function before and after bariatric surgery: a clinical overview

Weight Loss and Heart Failure

Early Weight Loss Independent Effects of Sleeve Gastrectomy on Diet-Induced Cardiac Dysfunction in Obese, Wistar Rats

Contact Info

Product

Resources

About