Bariatric Surgery for Congestive Heart Failure Patients Improves Access to Transplantation and Long-term Survival

Area of Science:

• Cardiology
• Bariatric Surgery
• Transplantation Medicine

Background:

• Obese patients with congestive heart failure (CHF) face strict BMI criteria (<35 kg/m²) for heart transplantation.
• The impact of rapid weight loss from bariatric surgery on transplant eligibility and survival for these patients is not well understood.

Purpose of the Study:

• To evaluate the effect of bariatric surgery (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]) on heart transplant waitlist placement and survival in morbidly obese CHF patients.
• To compare the long-term survival outcomes of RYGB, SG, and medical weight management (MWM).

Main Methods:

• A decision analytic Markov state transition model simulated the lifespans of morbidly obese CHF patients with a baseline BMI of 45 kg/m².
• The model estimated life expectancy for patients undergoing MWM, RYGB, and SG.
• Markov parameters were derived from a comprehensive literature review, and sensitivity analysis was performed on initial BMI.

Main Results:

• Roux-en-Y gastric bypass (RYGB) demonstrated superior survival outcomes compared to both sleeve gastrectomy (SG) and medical weight management (MWM).
• RYGB led to higher heart transplantation rates, resulting in improved mean long-term survival.
• Base case patients undergoing RYGB gained an average of 2.1 years over SG and 7.4 years over MWM; SG patients gained 5.3 years over MWM.

Conclusions:

• Bariatric surgery, particularly RYGB, enhances access to heart transplantation and increases long-term survival for morbidly obese CHF patients meeting strict waitlist criteria.
• Morbidly obese CHF patients considering heart transplantation should be counseled on surgical weight management options.
• Multidisciplinary collaboration among bariatric surgeons, cardiologists, and cardiac surgeons is crucial for managing perioperative risks.