Cardiovascular complications of obesity surgery in patients with increased preoperative cardiac risk
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Published on: November 14, 2020
Bosede A Afolabi1, Gian M Novaro, Samuel Szomstein
1Department of Cardiology, Bariatric and Metabolic Institute, Section of Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Insights
Obesity surgery is safe for patients with cardiac risks, showing a low rate of cardiovascular events. Preoperative stress testing often yields false positives and rarely leads to necessary interventions.
Area of Science:
- Cardiology
- Bariatric Surgery
- Cardiovascular Health
Background:
- Obesity surgery modifies cardiovascular risk factors, potentially reducing long-term events.
- However, bariatric procedures may increase cardiovascular risks in certain patient groups.
- Assessing these risks is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of cardiovascular events following obesity surgery.
- To evaluate patients with pre-existing cardiac risk factors undergoing bariatric procedures.
- To assess the utility of preoperative cardiac evaluations.
Main Methods:
- Retrospective analysis of 154 patients undergoing obesity surgery (2003-2006).
- Evaluation of beta-blocker use, noninvasive stress testing, and perioperative events.
- Analysis focused on patients with increased cardiac risk profiles.
Main Results:
- 3.2% of patients experienced nonfatal cardiac events; in-hospital mortality was 0%.
- 50% of patients underwent noninvasive stress testing, with 32% showing positive results.
- Only one positive stress test led to intervention after cardiac catheterization.
Conclusions:
- Obesity surgery is safe for patients with coronary heart disease or risk factors.
- The procedure is well-tolerated with a low rate of cardiac events.
- Noninvasive stress testing frequently produced false positives and rarely prompted intervention.
Background:
Obesity surgery reduces the incidence of long-term cardiovascular events by modifying the associated risk factors. The derived benefits of weight loss surgery might be counterbalanced by the increased cardiovascular risks in some patients. The primary objective of the present study was to determine the rate of cardiovascular events after obesity surgery in patients considered to have an increased cardiac risk profile at a tertiary referral hospital.
Methods:
A retrospective analysis of the data from consecutive patients who underwent obesity surgery at the Cleveland Clinic Florida was performed. The use of beta-blockers, noninvasive stress testing, and perioperative events were assessed.
Results:
The data from 154 patients who had undergone a preoperative cardiac consultation at the Cleveland Clinic Florida before obesity surgery from 2003 to 2006 were analyzed. Most patients were women (n = 108, 69%), and 25 (16%) were >65 years old. The number of patients who received perioperative beta-blockers was 72 (47%). Noninvasive stress testing was performed in 78 patients (50%). Of the 78 patients who underwent noninvasive stress testing, 25 (32%) had a positive finding. Only 1 patient with positive stress test results had an obstructive coronary artery lesion found on cardiac catheterization. A total of 5 nonfatal cardiac-related events (3.2%) occurred. The in-hospital mortality rate was 0%.
Conclusion:
Obesity surgery in patients with established coronary heart disease or risk factors is a safe and well-tolerated procedure, with an overall low rate of cardiac events. Noninvasive stress testing in this population resulted in a high rate of false-positive results and uncommonly led to intervention.
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