A SECOND CHANCE FOR A NEW HEART? THE ROLE OF BARIATRIC SURGERY IN PATIENTS WITH END-STAGE HEART FAILURE
Deanna L. Palenzuela*, Divyansh Agarwal, Denise Gee
Department of Surgery, Massachusetts General Hospital, Boston, MA
Introduction
Obesity is an independent risk factor for heart failure (HF). Substantial weight loss has been shown to reverse obesity-related cardiomyopathy. In severe cases of HF, obesity can further limit a patient's eligibility for heart transplant. The goal of this study was to report our institution's experience with laparoscopic sleeve gastrectomy (LSG) in morbidly obese end-stage HF patients.
Methods
Between 2018-2022, 26 patients with end-stage heart failure were referred for LSG at a tertiary care center. Of those patients, 16 underwent an operation while 10 did not. A retrospective chart review was conducted, and the following outcomes evaluated: (a) average age at the time of referral (b) number of patients with a ventricular assist device (VAD) (c) preoperative weight (d) total decrease in body mass index (BMI), (e) whether the patient underwent heart transplantation, and (f) mortality. Data analysis was performed using Stata (SE 17.0). Wilcoxon Rank Sum test were used to compare continuous variables between the cohorts, and Pearson Chi Squared test used for binary variables with Bonferroni correction applied.
Results
The LSG and non-LSG cohorts had comparable ages (p=0.088), preoperative BMI (p=0.918), and number of VAD patients (p=0.191). Patients who underwent LSG lost significantly more weight than the patients who did not undergo LSG, with an average decrease in BMI of 8.9 kg/m2 (SD±6.13) and 1.1 kg/m2 (SD±4.10), respectively (p=0.040). Six (37.5%) LSG patients eventually underwent transplantation, compared to two (20.0%) patients from the matched cohort (p=0.884). Of the 26 total patients, there were 6 deaths: 2 (12.5%) in the LSG cohort, and 4 (40.0%) in the non-LSG cohort (p=0.525).
Conclusion
LSG appears to be safe and effective for weight loss in patients with heart failure. This operation may provide morbidly obese end-stage HF patients the life-saving opportunity to achieve transplant candidacy. Future studies with larger patient cohorts are underway.
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