Role of bariatric surgery in patients with advanced heart failure

Although bariatric surgery (BaS) is an important treatment option to treat obesity in general, the safety and efficacy of BaS in patients with advanced heart failure (HF) are not well known.

To describe the trajectory of patients with advanced HF who underwent BaS and cardiac replacement therapy.

Single-tertiary academic hospital.

We conducted a retrospective study of patients with advanced HF with obesity (body mass index [BMI] >35 kg/m²) between January 2010 and August 2022. Among them, 15 patients underwent BaS, and their clinical trajectories were compared with 62 patients with advanced HF who received orthotopic heart transplant (OHT) or durable mechanical circulatory support without BaS (non-BaS group) during the same period. Key outcomes included BMI reduction, OHT eligibility, and post-OHT survival.

Among 15 patients who underwent BaS, 12 underwent sleeve gastrectomy and 3 underwent gastric bypass surgery. After a median duration of 11 (6-14) months from BaS, the mean value of BMI was significantly reduced (39.8 [39.0-42.2] kg/m² versus 31.6 [27.7-35.3] kg/m², P < .001) with no BaS related mortality. In subgroup of OHT patients, post-OHT survival was comparable between the 2 groups.

BaS is a safe and effective intervention for BMI reduction in patients with advanced HF. BaS may enhance OHT eligibility without compromising posttransplantation outcomes.