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Bariatric surgery in patients with advanced heart failure: A proposed multi-disciplinary pathway for surgical care in

Tammy L Kindel1, Rana M Higgins1, Kate Lak1

  • 1Division of Minimally Invasive Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.

Surgery
|May 30, 2021
PubMed

Insights

Developing a multidisciplinary care pathway enables bariatric surgery for advanced heart failure patients, improving outcomes and minimizing complications. This approach offers weight loss as a bridge to transplant or cardiac recovery.

Area of Science:

  • Cardiology
  • Bariatric Surgery
  • Critical Care Medicine

Background:

  • Patients with severe obesity and advanced heart failure face elevated perioperative risks.
  • Bariatric surgery programs often exclude these high-risk patients due to safety concerns.
  • Potential benefits of bariatric surgery for advanced heart failure warrant investigation into risk mitigation strategies.

Purpose of the Study:

  • To develop and evaluate a multidisciplinary care pathway for patients with advanced heart failure undergoing bariatric surgery.
  • To minimize perioperative complications in this high-risk patient population.
  • To assess short-term and 6-month outcomes, including cardiac function and weight loss.

Main Methods:

  • Two distinct multidisciplinary care pathways were created, involving specialists in advanced heart failure, anticoagulation, and transplant cardiology.
  • The pathways were implemented in severely obese patients with advanced heart failure, with or without mechanical circulatory support.
  • Outcomes evaluated included 30-day complications, 6-month cardiac function, and weight loss.

Main Results:

  • No in-hospital complications or mortality were observed across implemented pathways.
  • Low rates of emergency room visits (1) and re-admissions (1) were recorded.
  • Significant improvements included increased ejection fraction (average 9%) and three patients meeting transplant listing criteria at 6 months.

Conclusions:

  • Multidisciplinary care pathways can safely facilitate bariatric surgery in advanced heart failure patients.
  • Intensive preoperative cardiac optimization and postoperative medication management are key to maximizing safety.
  • Bariatric surgery offers a viable option for weight loss, potentially serving as a bridge to transplant or promoting cardiac recovery.
Abstract

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