Choon-Pin Lim1,2, Oliver M Fisher3, Dan Falkenback3,4, Damien Boyd5, Christopher S Hayward1, Anne Keogh1, Katherine Samaras6,7, Peter MacDonald1, Reginald V Lord8,9. 1. Heart Transplant Unit, St Vincent's Hospital, Sydney, Australia. 2. Cardiology Department, National Heart Centre Singapore, Singapore, Singapore. 3. St Vincent's Centre for Applied Medical Research, Sydney, Australia. 4. Department of Surgery, Lund University and Lund University Hospital (SUS Skane), 221 85, Lund, Sweden. 5. Department of Anesthetics, St Vincent's Hospital, Sydney, Australia. 6. Department of Endocrinology, St Vincent's Hospital, Sydney, Australia. 7. Diabetes and Obesity Program, Garvan Institute of Medical Research, Sydney, Australia. 8. St Vincent's Centre for Applied Medical Research, Sydney, Australia. rvlord@stvincents.com.au. 9. Department of Surgery, University of Notre Dame, School of Medicine, St. Vincent's Hospital, Sydney, Australia. rvlord@stvincents.com.au.
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.
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 obesepatients 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 obesepatients with advanced cardiac failure, enabling successful heart transplantation. In some patients, cardiac transplantation can be avoided through surgical weight loss.
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