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Efficacy of bariatric intervention as a bridge to cardiac transplant
Theo Sher1, Madison Noom1, Abdul-Rahman Diab1
1Department of Surgery, University of South Florida, Tampa, Florida.
Insights
Bariatric interventions significantly reduce weight and BMI in heart failure patients awaiting transplants. This approach may improve eligibility for cardiac transplantation by addressing obesity.
Area of Science:
- Cardiology
- Bariatric Medicine
- Transplantation Medicine
Background:
- Many heart failure (HF) patients are ineligible for cardiac transplantation due to high body mass index (BMI).
- Bariatric interventions offer a potential pathway for weight reduction, improving transplant eligibility.
Purpose of the Study:
- To evaluate the safety and efficacy of bariatric interventions in obese patients with HF awaiting cardiac transplantation.
- To compare outcomes between surgical and nonsurgical bariatric interventions.
Main Methods:
- Mixed retrospective/prospective study of 18 HF patients with BMI >35 kg/m².
- Patients categorized by bariatric surgery vs. nonsurgical intervention and advanced HF therapy.
- Weight, BMI, and left ventricular ejection fraction (LVEF) assessed pre-intervention and 6 months post-intervention.
Main Results:
- Bariatric surgery resulted in significant weight loss (18.6 kg) and BMI reduction (6.4 kg/m²) compared to nonsurgical methods (1.9 kg, 0.7 kg/m²).
- Surgical patients showed a trend toward improved LVEF (+5.9%), while nonsurgical patients showed a trend toward decreased LVEF (-5.9%).
- No patients were lost to follow-up, indicating good tolerability.
Conclusions:
- Bariatric intervention is a safe and effective strategy for weight and BMI reduction in obese patients with HF.
- These findings support bariatric intervention as a viable option for improving cardiac transplant candidacy.
Background:
Many patients with heart failure (HF) are denied cardiac transplants due to inability to meet transplantation body mass index (BMI) criteria. Bariatric intervention, including surgery, medication, and weight loss guidance, may help patients lose weight and become eligible for transplantation.
Objective:
We aim to contribute to the literature on the safety and efficacy of bariatric intervention on patients with obesity and HF who are awaiting cardiac transplantation.
Setting:
University hospital, United States.
Methods:
This was a mixed retrospective/prospective study. Eighteen patients with HF and BMI >35 kg/m2 were reviewed. Patients were divided based on whether they underwent bariatric surgery or nonsurgical intervention and whether they had left ventricular assist devices or other advanced heart failure therapy including inotropic support, guideline-directed medical therapy, and/or temporary mechanical circulatory support. Weight, BMI, and left ventricular ejection fraction (LVEF) were collected before bariatric intervention and 6 months after bariatric intervention.
Results:
No patients were lost to follow-up. Bariatric surgery led to statistically significant decreases in weight and BMI when compared with nonsurgical patients. At 6 months after intervention, surgical patients lost an average of 18.6 kg and decreased their BMI by 6.4 kg/m2 while nonsurgical patients lost 1.9 kg and decreased their BMI by .7 kg/m2. After bariatric intervention, surgical patients had an average LVEF increase of 5.9% and nonsurgical patients had an average decrease of 5.9%, although these findings lacked statistical significance.
Conclusion:
Our study suggests that bariatric intervention among patients with HF and obesity is a safe and effective method of weight and BMI reduction.
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