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Evaluation and treatment of patients with cardiac disease undergoing bariatric surgery
Namir Katkhouda1, Rodney J Mason, Bob Wu
1Division of General and Laparoscopic Surgery, Department of Surgery, University of Southern California, Los Angeles, California 90033, USA. nkatkhouda@surgery.usc.edu
Insights
Bariatric surgery can be safe for obese patients with heart disease when preoperative cardiac risk is assessed and managed. Evidence-based strategies ensure good outcomes for these complex surgical cases.
Area of Science:
- Cardiology
- Bariatric Surgery
- Perioperative Medicine
Background:
- Morbid obesity is linked to numerous comorbidities.
- Bariatric surgery effectively reduces these associated health issues.
- Managing cardiac disease in patients undergoing bariatric surgery requires specific strategies.
Purpose of the Study:
- To review current data on preoperative evaluation and management for obese patients with cardiac disease undergoing bariatric surgery.
- To discuss strategies for patients with prior coronary interventions and antiplatelet therapy.
- To outline best practices for safe perioperative care.
Main Methods:
- Conducted a literature search using keywords: morbid obesity, bariatric surgery, perioperative risk assessment, coronary artery disease, coronary stents, and antiplatelet therapy.
- Focused on English-language reports.
- Synthesized findings on risk assessment and management strategies.
Main Results:
- Preoperative cardiac risk assessment methods include clinical criteria, stress echocardiography, and SPECT.
- Optimization with beta-blockers and statins is recommended preoperatively.
- Aspirin (81 mg) can be continued perioperatively; clopidogrel requires cautious management.
Conclusions:
- Preoperative assessment of morbidly obese patients with cardiac disease poses unique challenges.
- Adherence to evidence-based practices is crucial for safe patient care.
- Effective management leads to favorable clinical outcomes in this patient population.
Background:
Bariatric surgery is a proven tool in reducing the co-morbidities associated with morbid obesity. The aim of the present review was to assess the current data and discuss the strategies for preoperative evaluation, preoperative treatment, and intraoperative management of the obese patient with cardiac disease seeking bariatric surgery, including those who have undergone previous angiographic intervention with coronary stenting and/or antiplatelet therapy. The setting was a university hospital in the United States.
Methods:
A search of the English-language reports using the keywords morbid obesity, bariatric surgery, perioperative risk assessment, coronary artery disease, coronary stents, and antiplatelet therapy was conducted.
Results:
The methods of preoperative cardiac risk assessment found in the published studies included the use of certain criteria, stress echocardiography, and single-photon emission computed tomography. Preoperative medical treatment optimization with β-blockers and statins is recommended. Perioperative antiplatelet therapy in the form of aspirin 81 mg can be safely continued, but clopidogrel should be stopped and reinitiated with caution.
Conclusion:
Preoperative assessment of morbidly obese patients with coexisting cardiac issues presents unique challenges. Safe patient care and good clinical outcomes can be achieved with adherence to evidence-based practice.
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