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Amdahl MB, Sundaram V, Reddy YNV. Obesity in Heart Failure with Reduced Ejection Fraction: Time to Address the Elephant in the Room. Heart Fail Clin 2024; 20:399-406. [PMID: 39216925 DOI: 10.1016/j.hfc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Obesity has been long recognized as a risk factor for the development of heart failure, but recent evidence suggests obesity is more typically associated with heart failure with preserved ejection fraction as opposed to heart failure with reduced ejection fraction (HFrEF). Nevertheless, numerous studies have found that obesity modulates the presentation and progression of HFrEF and may contribute to the development of HFrEF in some patients. Although obesity has definite negative effects in HFrEF patients, the effects of intentional weight loss in HFrEF patients with obesity have been poorly studied.
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Affiliation(s)
- Matthew B Amdahl
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Varun Sundaram
- Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; University Hospitals Medical Center, Cleveland, OH, USA.
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daSilva-deAbreu A, Rodgers JE, Seltz J, Mandras SA, Lavie CJ, Loro-Ferrer JF, Ventura HO, Schauer PR, Vest AR. Obesity, Challenges, and Weight-Loss Strategies for Patients With Ventricular Assist Devices. JACC. HEART FAILURE 2024; 12:1661-1676. [PMID: 38904644 DOI: 10.1016/j.jchf.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 06/22/2024]
Abstract
For adults with advanced heart failure, class II/III obesity (body mass index ≥35 kg/m2) represents major challenges, and it is even considered a contraindication for heart transplantation (HT) at many centers. This has led to growing interest in preventing and treating obesity to help patients with advanced heart failure become HT candidates. Among all weight-loss strategies, bariatric surgery (BSx) has the greatest weight loss efficacy and has shown value in enabling select patients with left ventricular assist devices (LVADs) and obesity to lose sufficient weight to access HT. Nevertheless, both BSx and antiobesity medications warrant caution in the LVAD population. In this review, the authors describe and interpret the available published reports on the impact of obesity and weight-loss strategies for patients with LVADs from general and HT candidacy standpoints. The authors also provide an overview of the journey of LVAD recipients who undergo BSx and review major aspects of perioperative protocols.
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Affiliation(s)
- Adrian daSilva-deAbreu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Jo E Rodgers
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jessica Seltz
- Frances Stern Nutrition Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stacy A Mandras
- Transplant Institute, AdventHealth Orlando, Orlando, Florida, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine New Orleans, Louisiana, USA
| | | | - Hector O Ventura
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine New Orleans, Louisiana, USA
| | - Philip R Schauer
- Metamor Metabolic Institute, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda R Vest
- Division of Cardiology, The CardioVascular Center, Tufts Medical Center, Boston, Massachusetts, USA
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Amdahl MB, Sundaram V, Reddy YNV. Obesity in Heart Failure with Reduced Ejection Fraction: Time to Address the Elephant in the Room. Cardiol Clin 2023; 41:537-544. [PMID: 37743076 DOI: 10.1016/j.ccl.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Obesity has been long recognized as a risk factor for the development of heart failure, but recent evidence suggests obesity is more typically associated with heart failure with preserved ejection fraction as opposed to heart failure with reduced ejection fraction (HFrEF). Nevertheless, numerous studies have found that obesity modulates the presentation and progression of HFrEF and may contribute to the development of HFrEF in some patients. Although obesity has definite negative effects in HFrEF patients, the effects of intentional weight loss in HFrEF patients with obesity have been poorly studied.
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Affiliation(s)
- Matthew B Amdahl
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Varun Sundaram
- Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, 10701 East Blvd, Cleveland, OH 44106, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; University Hospitals Medical Center, Cleveland, OH, USA.
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Tsai C, Dolan P, Moss N, Sandoval AF, Roldan J, Herron DM. Sleeve gastrectomy facilitates weight loss and permits cardiac transplantation in patients with severe obesity and a left ventricular assist device (LVAD). Surg Endosc 2023; 37:8655-8662. [PMID: 37495848 DOI: 10.1007/s00464-023-10264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Patients suffering from advanced heart failure may undergo left ventricular assist device (LVAD) placement as a bridge to cardiac transplantation. However, those with a BMI above 35 kg/m2 are generally not considered eligible for transplant due to their elevated cardiac risk. We review our experience with bariatric surgery in this high-risk population to assess its safety and efficacy in reducing BMI to permit cardiac transplantation. METHODS We retrospectively reviewed all patients on durable LVAD support who underwent sleeve gastrectomy (SG) at Mount Sinai Hospital between August 2018 and December 2022. Electronic medical records were reviewed to analyze patient demographics, surgical details, and outcomes regarding weight loss and heart transplantation. RESULTS We identified twelve LVAD patients who underwent SG. Three were performed laparoscopically and 9 via robotic approach. Four patients (33.3%) underwent an orthotopic heart transplant (OHTx). Half of these patients were female. For patients who underwent OHTx, mean age at LVAD placement was 41.0 (R30.6-52.2), at SG was 43.9 (R32.7-55.0) and at OHTx was 45.3 years (R33.3-56.8). Mean BMI increased from 38.8 at LVAD placement to 42.5 prior to SG. Mean time from SG to OHTx was 17.9 months (R6-7-27.5) during which BMI decreased to mean 32.8 at the time of OHTx. At most recent follow-up, mean BMI was 31.9. All patients were anticoagulated prior to surgery; one required return to the operating room on post-operative day 1 after SG for bleeding and one was re-admitted on post-operative day 7 for hematochezia treated conservatively. CONCLUSION SG is a safe and effective operation in patients with severe obesity and heart failure requiring an LVAD. 66.7% of our cohort achieved target BMI < 35 and 33.3% underwent heart transplantation. Longer term follow-up is needed to clarify full bridge-to-transplant rate and long-term survival outcomes.
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Affiliation(s)
- Catherine Tsai
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Patrick Dolan
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Noah Moss
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | | | - Julie Roldan
- Department of Cardiology, Mount Sinai Health System, New York, USA
| | - Daniel M Herron
- Department of Surgery, Mount Sinai Health System, 1 Gustave L. Levy Place, New York, NY, 10029, USA
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Ng M, Rodgers B, Rehman S, Nathan SS, Bajwa KS, Shah SK, Akkanti BH, Jumean MF, Kumar S, Dressel JL, Radovancevic R, Felinski MM, Kar B, Gregoric ID. Left Ventricular Assist Device Support and Longitudinal Sleeve Gastrectomy Combined With Diet in Bridge to Heart Transplant. Tex Heart Inst J 2022; 49:478098. [PMID: 35201356 DOI: 10.14503/thij-20-7521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Combining left ventricular assist device (LVAD) implantation and longitudinal sleeve gastrectomy may enable patients with morbid obesity to lose enough weight for heart transplant eligibility. In a retrospective study, we evaluated long-term outcomes of patients with body mass indexes ≥35 who underwent LVAD implantation and longitudinal sleeve gastrectomy during the same hospitalization (from January 2013 through July 2018) and then adhered to a dietary protocol. We included 22 patients (mean age, 49.9 ± 12.5 yr; mean preoperative body mass index, 43.3 ± 6.2). Eighteen months after gastrectomy, all 22 patients were alive, and 16 (73%) achieved a body mass index of less than 35. Myocardial recovery in 2 patients enabled LVAD removal. As of October 2020, 10 patients (45.5%) had undergone heart transplantation, 5 (22.3%) were waitlisted, 5 (22.3%) still had a body mass index ≥35, and 2 (9%) had died. With LVAD support, longitudinal sleeve gastrectomy, and dietary protocols, most of our patients with morbid obesity and advanced heart failure lost enough weight for transplant eligibility. Support from physicians and dietitians can maximize positive results in these patients.
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Affiliation(s)
- Mandy Ng
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Beverly Rodgers
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Saadiya Rehman
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Sriram S Nathan
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Kulvinder S Bajwa
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shinil K Shah
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Bindu H Akkanti
- Division of Critical Care Medicine, University of Texas McGovern Medical School, Houston, Texas.,Division of Pulmonary and Sleep Medicine, University of Texas McGovern Medical School, Houston, Texas
| | - Marwan F Jumean
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Jennifer L Dressel
- Clinical Nutrition, Memorial Hermann-Texas Medical Center, Houston, Texas
| | - Rajko Radovancevic
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Melissa M Felinski
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston, Houston, Texas
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Scheibe CL, Pinto LEV, Valadão JA, de Oliveira CMB, Moura ECR, Campelo GP, de Lima RC, Freire TT, de Oliveira EJSG, da Cunha Leal P. Laparoscopic Bypass in Morbidly Obese Patient with End-Stage Heart Failure: Case Report. Obes Surg 2021; 31:5059-5062. [PMID: 34212344 DOI: 10.1007/s11695-021-05549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/12/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
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Clinical Outcomes, Trends in Weight, and Weight Loss Strategies in Patients With Obesity After Durable Ventricular Assist Device Implantation. Curr Heart Fail Rep 2021; 18:52-63. [PMID: 33420916 DOI: 10.1007/s11897-020-00500-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To discuss clinical outcomes, changes in weight, and weight loss strategies of patients with obesity post left ventricular assist device (LVAD) implantation. RECENT FINDINGS Despite increased complications in patients with obesity after LVAD implantation, survival is comparable to patients without obesity. A minority of patients with obesity lose significant weight and become eligible for heart transplantation after LVAD implantation. In fact, a great majority of such patients gain weight post-implantation. Obesity by itself should not be considered prohibitive for LVAD therapy but, rather, should be incorporated into the overall risk assessment for LVAD implantation. Concerted strategies should be developed to promote sustainable weight loss in patients with obesity and LVAD to improve quality of life, eligibility, and outcomes after heart transplantation. Investigation of the long-term impact of weight loss on patients with obesity with LVAD is warranted.
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis. J Card Fail 2020; 27:338-348. [PMID: 33358959 DOI: 10.1016/j.cardfail.2020.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. METHODS AND RESULTS We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho -0.671; P< .00001). Among 23 patients with documented listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m2/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3-17 months). Patients with a BMI<45 kg/m2 had a higher chance of achieving the composite outcome (P< .003). CONCLUSIONS BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana; Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
| | | | - Yuhamy Curbelo-Pena
- Service of General Surgery, Consorci Sanitari de l'Alt Penedes i Garraf, Barcelona, Spain
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
| | | | - Stacy A Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana
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daSilva-deAbreu A, Garikapati K, Alhafez BA, Desai S, Eiswirth C, Krim S, Patel H, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Laparoscopic sleeve gastrectomy in obese patients with ventricular assist devices: a data note. BMC Res Notes 2020; 13:439. [PMID: 32938487 PMCID: PMC7496210 DOI: 10.1186/s13104-020-05272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight after implantation, which is associated with higher complication rates and is a contraindication for heart transplantation (HT). The objective was to analyze the outcomes of obese patients with ESHF and VADs who underwent laparoscopic sleeve gastrectomy (LSG) at Ochsner Medical Center in New Orleans, which is the only program performing VADs and HT in the State of Louisiana, and also one of the largest VAD centers in the USA. DATA DESCRIPTION This dataset contains detailed baseline, perioperative, and long-term data of patients with VADs undergoing LSG. These variables were collected retrospectively from electronic medical records. Patients who achieved ≥ 50% excess BMI loss, BMI ≤ 35 kg/m2, listing for HT, HT, or myocardial recovery were identified and the timing to each of these milestones was documented. These data can be used alone or in combination with other datasets to achieve a larger sample size with more power for further analysis of these variables, which include the most important, standard, and objective bariatric and ESHF outcomes of patients with VADs undergoing LSG. Elaboration of composite outcomes is feasible.
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Affiliation(s)
- Adrian daSilva-deAbreu
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Kiran Garikapati
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
| | | | - Sapna Desai
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Clement Eiswirth
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Selim Krim
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hamang Patel
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Carl J. Lavie
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hector O. Ventura
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | | | - Stacy A. Mandras
- The John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
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Orandi BJ, Purvis JW, Cannon RM, Smith AB, Lewis CE, Terrault NA, Locke JE. Bariatric surgery to achieve transplant in end-stage organ disease patients: A systematic review and meta-analysis. Am J Surg 2020; 220:566-579. [PMID: 32600846 PMCID: PMC7484004 DOI: 10.1016/j.amjsurg.2020.04.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND As obesity prevalence grows, more end-stage organ disease patients will be precluded from transplant. Numerous reports suggest bariatric surgery in end-stage organ disease may help patients achieve weight loss sufficient for transplant listing. METHODS We performed a systematic review/meta-analysis of studies of bariatric surgery to achieve solid organ transplant listing. RESULTS Among 82 heart failure patients, 40.2% lost sufficient weight for listing, 29.3% were transplanted, and 8.5% had sufficient improvement with weight loss they no longer required transplantation. Among 28 end-stage lung disease patients, 28.6% lost sufficient weight for listing, 7.1% were transplanted, and 14.3% had sufficient improvement following weight loss they no longer required transplant. Among 41 cirrhosis patients, 58.5% lost sufficient weight for listing, 41.5% were transplanted, and 21.9% had sufficient improvement following weight loss they no longer required transplant. Among 288 end-stage/chronic kidney disease patients, 50.3% lost sufficient weight for listing and 29.5% were transplanted. CONCLUSIONS Small sample size and publication bias are limitations; however, bariatric surgery may benefit select end-stage organ disease patients with obesity that precludes transplant candidacy.
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Affiliation(s)
- Babak J Orandi
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States.
| | - Joshua W Purvis
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
| | - Robert M Cannon
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
| | - A Blair Smith
- University of Alabama at Birmingham Schools of Medicine, Department of Anesthesia, United States
| | - Cora E Lewis
- University of Alabama at Birmingham Schools of Medicine, Department of Medicine, United States; University of Alabama at Birmingham Schools of Medicine, Public Health, United States
| | - Norah A Terrault
- University of Southern California Keck School of Medicine, Department of Medicine, United States
| | - Jayme E Locke
- University of Alabama at Birmingham Schools of Medicine, Department of Surgery, United States
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daSilva-deAbreu A, Alhafez BA, Curbelo-Pena Y, Lavie CJ, Ventura HO, Loro-Ferrer JF, Mandras SA. Bariatric surgery in obese patients with ventricular assist devices. BMC Res Notes 2020; 13:382. [PMID: 32795382 PMCID: PMC7427728 DOI: 10.1186/s13104-020-05221-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Patients with end-stage heart failure (ESHF) treated with ventricular assist devices (VADs) tend to gain weight, which may prevent them from receiving heart transplantation (HT) if their body mass index (BMI) reaches ≥ 35 kg/m2. The objective was to synthesize all cases available in the literature and describe the most important outcomes of bariatric surgery (BS) in VAD patients, including BMI trends, reaching a BMI < 35 kg/m2, listing for HT, achieving HT, myocardial recovery, and mortality. These data were obtained for an individual participant data (IPD) meta-analysis and include available IPD for every case in the scientific literature describing VAD patients undergoing BS during VAD support with documented postoperative BMI (and time of measurement) during follow-up. DATA DESCRIPTION These data include baseline, periprocedural, and long-term outcomes for the 29 patients meeting selection criteria. The composite outcome includes reaching a BMI < 35 kg/m2, listing for HT, receiving HT, and myocardial recovery, indicating significant BMI loss associated with major ESHF outcomes. As multiple centers are becoming more experienced in this field, the present data can be merged with their databases to form larger samples that will allow to perform further statistical analysis to identify outcome predictors and improve clinical protocols and outcomes.
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Affiliation(s)
- Adrian daSilva-deAbreu
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
- Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Yuhamy Curbelo-Pena
- Service of General Surgery, Consorci Sanitari de L’Alt Penedes I Garraf, Barcelona, Spain
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | - Hector O. Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
| | | | - Stacy A. Mandras
- John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, LA USA
- The University of Queensland Ochsner Clinical School, Faculty of Medicine, The University of Queensland, New Orleans, LA USA
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Kiernan MS, Najjar SS, Vest AR, Birks EJ, Uriel N, Ewald GA, Leadley K, Patel CB. Outcomes of Severely Obese Patients Supported by a Centrifugal-Flow Left Ventricular Assist Device. J Card Fail 2020; 26:120-127. [DOI: 10.1016/j.cardfail.2019.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
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Albert CL. Morbid Obesity as a Therapeutic Target for Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:52. [DOI: 10.1007/s11936-019-0754-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Laparoscopic Sleeve Gastrectomy in Heart Failure Patients with Left Ventricular Assist Device. Obes Surg 2019; 29:1122-1129. [DOI: 10.1007/s11695-018-3570-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Greene J, Tran T, Shope T. Sleeve Gastrectomy and Left Ventricular Assist Device for Heart Transplant. JSLS 2018; 21:JSLS.2017.00049. [PMID: 28951657 PMCID: PMC5610117 DOI: 10.4293/jsls.2017.00049] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Heart failure (HF) is a severe obesity-related comorbidity. Many patients with end-stage HF eventually require cardiac transplantation for long-term survival. These patients may be precluded from enrollment in heart transplant programs secondary to morbid obesity. We propose a pathway involving sleeve gastrectomy (SG) for patients with morbid obesity and HF to afford cardiac transplantation eligibility. METHODS Three patients with HF and morbid obesity underwent implantation of a left ventricular assist device (LVAD) and SG at an academic tertiary care institution in Washington, DC. This retrospective review from April 2012 through January 2017 examines the perioperative course of these 3 patients with regard to bariatric and cardiac indices, including ejection fraction (EF), HF classification, comorbid diseases, and percentages of total weight loss (%TWL) and excess weight loss (%EWL). RESULTS All three patients underwent LVAD placement as a bridge to transplant but were excluded from cardiac transplantation secondary to body mass index (BMI) and were referred for bariatric surgery. All have demonstrated considerable weight loss, with average decrease in BMI of 19 points, 39% TWL, and 81% EWL at a mean of 44 months after SG. Two patients have gone on to receive heart transplants, with near normalization of their EF. CONCLUSION LVAD and SG constitute a feasible pathway to cardiac transplantation in morbidly obese patients with end-stage HF. LVAD permits temporary cardiac support, whereas SG assists in efficacious weight loss. We explore SG as a durable weight loss option in patients with HF, with LVAD to improve eligibility for orthotopic cardiac transplantation.
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Affiliation(s)
| | - Tung Tran
- Section of Advanced Laparoscopic and Bariatric Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Timothy Shope
- Section of Advanced Laparoscopic and Bariatric Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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16
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Kettyle SM, Chervu NL, Rao AS, Sadi S, Majure D, Sava JA, Johnson LS. Outcomes following Noncardiac Surgery in Patients with Ventricular Assist Devices: A Single-Center Experience. Am Surg 2017. [DOI: 10.1177/000313481708300833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Prevalence of ventricular assist devices (VADs) is increasing as advanced cardiac therapies progress. These patients commonly require non-cardiac surgical procedures (NCS), although data are scant regarding the safety, timing, and operations that may safely be performed. We aim to describe our experience with VAD patients undergoing NCS. We retrospectively reviewed records on patients who underwent NCS after VAD implantation between 2013 and 2015 at a single Joint Commission–accredited VAD institution. Data collection included demographics, ischemic cardiomyopathy or nonischemic cardiomyopathy, operative details, and perioperative anticoagulation management and outcomes. Seventy-two NCS were performed by general surgeons, thoracic surgeons, plastic surgeons, urologists, vascular surgeons, ENTs, and other services. Procedures were similarly varied, including video-assisted thoracoscopy with decortications or lung biopsy, tracheostomies, percutaneous endoscopic gastrostomies, exploratory laparotomies, and wound debridements and/or closures. The ten deaths in the study group were judged not to be directly related to NCS. Eleven cases had postoperative bleeding and two cases had postoperative thrombosis, including one pump thrombosis. Based on our results, VAD is not an absolute contraindication to NCS, and a variety of NCS procedures can safely be performed. Further study should focus on quantifying and mitigating the risk that VADs bring to NCS.
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Affiliation(s)
| | | | | | - Salaam Sadi
- MedStar Washington Hospital Center, Washington, DC
| | - David Majure
- MedStar Washington Hospital Center, Washington, DC
| | - Jack A. Sava
- MedStar Washington Hospital Center, Washington, DC
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17
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Vest AR, Patel P, Schauer PR, Satava ME, Cavalcante JL, Brethauer S, Young JB. Clinical and Echocardiographic Outcomes After Bariatric Surgery in Obese Patients With Left Ventricular Systolic Dysfunction. Circ Heart Fail 2016; 9:e002260. [PMID: 26945045 DOI: 10.1161/circheartfailure.115.002260] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a risk factor for development of left ventricular systolic dysfunction (LVSD) and can complicate LVSD management, especially for individuals in whom cardiac transplantation is indicated. Bariatric surgery is increasingly recognized as a safe and effective intervention to achieve marked weight loss, but experience is limited in the LVSD population. METHODS AND RESULTS We retrospectively reviewed patients with obesity and left ventricular ejection fraction (LVEF) <50% who underwent bariatric surgery at a tertiary center 2004 to 2013. An analysis of outcomes and efficacy compared 42 surgical patients with LVSD to 2588 without known LVSD. The LVSD group had greater baseline prevalence of comorbidities and showed a slight excess of early postoperative heart failure and myocardial infarction. However, patients with LVSD achieved good weight loss efficacy (mean decrease 22.6%) and no excess in mortality at 1 year. An overlapping cohort of 38 patients with LVSD had both pre- and postoperative echocardiographic images available for review by 2 blinded readers. Obese nonsurgical controls were matched on age, sex, initial LVEF, and interval between echocardiograms. There was a mean pre- to postoperative LVEF improvement of +5.1% ±8.3 (P=0.0005) for surgical subjects, but not for controls (+3.4%±10.5, P=0.056). Among surgical subjects, 11 patients had an LVEF improvement of >10%, whereas only 6 improved by >10% among nonsurgical controls. CONCLUSIONS At experienced centers, bariatric surgery may be a safe and effective intervention for obese patients with LVSD. Bariatric surgery was associated with an improvement in LVEF, although the magnitude of change was on the cusp of clinical significance.
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Affiliation(s)
- Amanda R Vest
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.).
| | - Parag Patel
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philip R Schauer
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Mary Ellen Satava
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L Cavalcante
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Stacy Brethauer
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - James B Young
- From the Division of Cardiology, Tufts Medical Center, Boston, MA (A.R.V.); Division of Cardiology, Centennial Hospital, Nashville, TN (P.P.); Bariatric and Metabolic Institute (P.R.S., S.B.), Quality and Patient Safety Institute (M.E.S.), Endocrinology and Metabolism Institute (J.B.Y.), and Heart and Vascular Institute (J.B.Y.), Cleveland Clinic, OH; and Department of Medicine, Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (J.L.C.)
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Chaudhry UI, Kanji A, Sai-Sudhakar CB, Higgins RS, Needleman BJ. Laparoscopic sleeve gastrectomy in morbidly obese patients with end-stage heart failure and left ventricular assist device: medium-term results. Surg Obes Relat Dis 2015; 11:88-93. [DOI: 10.1016/j.soard.2014.04.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/27/2014] [Accepted: 04/06/2014] [Indexed: 01/17/2023]
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19
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Salinas A, Mc Quattie Pimentel AC, Salinas HM. Roux-en-Y gastric bypass as metabolic treatment in a heart transplant patient with type 2 diabetes: 4 years later. Surg Obes Relat Dis 2014; 10:e81-3. [DOI: 10.1016/j.soard.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/04/2014] [Accepted: 03/05/2014] [Indexed: 01/06/2023]
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20
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Morrow EH, Pellegrini CA, Mokadam NA, Khandelwal S. Laparoscopic gastric bypass during left ventricular assist device support and ventricular recovery. J Heart Lung Transplant 2014; 33:870-1. [DOI: 10.1016/j.healun.2014.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/02/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022] Open
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