Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy

C. A. McCloskey, G. V. Ramani, M. A. Mathier, P. R. Schauer, G. M. Eid, Samer Mattar, A. P. Courcoulas, R. Ramanathan

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Background: Longstanding morbid obesity can be associated with severe cardiomyopathy. However, the safety and efficacy of bariatric surgery in patients with severe cardiomyopathy has not been studied, and the effect of surgical weight loss on postoperative cardiac function is also unknown. In addition, morbidly obese patients have significantly increased mortality associated with cardiac transplantation, often precluding them from becoming recipients. Methods: A retrospective study of patients with a left ventricular ejection fraction ≤35% who underwent bariatric surgery (1998-2005) was performed. Short-term morbidity/mortality, length of stay, excess weight loss, pre- and postoperative left ventricular ejection fraction, and New York Heart Association (NYHA) functional class were assessed. Results: A total of 14 patients (10 men and 4 women) with a mean preoperative body mass index of 50.8 ± 2.04 kg/m2 underwent bariatric surgery (10 underwent laparoscopic Roux-en-Y gastric bypass, 1 open Roux-en-Y gastric bypass, 2 sleeve gastrectomy, and 1 laparoscopic gastric banding). The complications were pulmonary edema in 1, hypotension in 1, and transient renal insufficiency in 2. The median length of stay was 3.0 days (range 2-9). The mean excess weight loss at 6 months was 50.4%, with a decrease in the mean body mass index from 50.8 ± 2.04 kg/m2 to 36.8 ± 1.72 kg/m2. The mean left ventricular ejection fraction at 6 months had significantly improved from 23% ± 2% to 32% ± 4% (P = .04), correlating with improved functional capacity, as measured by the NYHA classification. Preoperatively, 2 patients (14%) had an NYHA classification of IV, 6 (43%) a classification of III, and 6 (43%) a classification of II. At 6 months postoperatively, no patient had an NYHA classification of IV, 2 (14%) had a classification of III, and 12 (86%) an NYHA classification of II. Two patients had undergone cardiac transplant evaluations preoperatively and underwent successful transplantation after weight loss. Conclusion: The results of our study have shown that bariatric surgery for patients with cardiomyopathy is feasible and effective. Surgically induced weight loss results in both subjective and objective improvement in cardiac function. In addition, surgical weight loss can provide a bridge to transplantation in patients who were prohibited secondary to their morbid obesity.

Original languageEnglish (US)
Pages (from-to)503-507
Number of pages5
JournalSurgery for Obesity and Related Diseases
Volume3
Issue number5
DOIs
StatePublished - Sep 2007
Externally publishedYes

Fingerprint

Bariatric Surgery
Cardiomyopathies
Weight Loss
Stroke Volume
Gastric Bypass
Morbid Obesity
Length of Stay
Body Mass Index
Transplantation
Mortality
Pulmonary Edema
Heart Transplantation
Gastrectomy
Hypotension
Renal Insufficiency
Stomach
Retrospective Studies
Morbidity
Transplants
Safety

Keywords

  • Bariatric surgery
  • Body mass index
  • Cardiomyopathy
  • Gastric bypass
  • Heart failure
  • Morbid obesity

ASJC Scopus subject areas

  • Surgery

Cite this

McCloskey, C. A., Ramani, G. V., Mathier, M. A., Schauer, P. R., Eid, G. M., Mattar, S., ... Ramanathan, R. (2007). Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. Surgery for Obesity and Related Diseases, 3(5), 503-507. https://doi.org/10.1016/j.soard.2007.05.006

Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. / McCloskey, C. A.; Ramani, G. V.; Mathier, M. A.; Schauer, P. R.; Eid, G. M.; Mattar, Samer; Courcoulas, A. P.; Ramanathan, R.

In: Surgery for Obesity and Related Diseases, Vol. 3, No. 5, 09.2007, p. 503-507.

Research output: Contribution to journalArticle

McCloskey, CA, Ramani, GV, Mathier, MA, Schauer, PR, Eid, GM, Mattar, S, Courcoulas, AP & Ramanathan, R 2007, 'Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy', Surgery for Obesity and Related Diseases, vol. 3, no. 5, pp. 503-507. https://doi.org/10.1016/j.soard.2007.05.006
McCloskey, C. A. ; Ramani, G. V. ; Mathier, M. A. ; Schauer, P. R. ; Eid, G. M. ; Mattar, Samer ; Courcoulas, A. P. ; Ramanathan, R. / Bariatric surgery improves cardiac function in morbidly obese patients with severe cardiomyopathy. In: Surgery for Obesity and Related Diseases. 2007 ; Vol. 3, No. 5. pp. 503-507.
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abstract = "Background: Longstanding morbid obesity can be associated with severe cardiomyopathy. However, the safety and efficacy of bariatric surgery in patients with severe cardiomyopathy has not been studied, and the effect of surgical weight loss on postoperative cardiac function is also unknown. In addition, morbidly obese patients have significantly increased mortality associated with cardiac transplantation, often precluding them from becoming recipients. Methods: A retrospective study of patients with a left ventricular ejection fraction ≤35{\%} who underwent bariatric surgery (1998-2005) was performed. Short-term morbidity/mortality, length of stay, excess weight loss, pre- and postoperative left ventricular ejection fraction, and New York Heart Association (NYHA) functional class were assessed. Results: A total of 14 patients (10 men and 4 women) with a mean preoperative body mass index of 50.8 ± 2.04 kg/m2 underwent bariatric surgery (10 underwent laparoscopic Roux-en-Y gastric bypass, 1 open Roux-en-Y gastric bypass, 2 sleeve gastrectomy, and 1 laparoscopic gastric banding). The complications were pulmonary edema in 1, hypotension in 1, and transient renal insufficiency in 2. The median length of stay was 3.0 days (range 2-9). The mean excess weight loss at 6 months was 50.4{\%}, with a decrease in the mean body mass index from 50.8 ± 2.04 kg/m2 to 36.8 ± 1.72 kg/m2. The mean left ventricular ejection fraction at 6 months had significantly improved from 23{\%} ± 2{\%} to 32{\%} ± 4{\%} (P = .04), correlating with improved functional capacity, as measured by the NYHA classification. Preoperatively, 2 patients (14{\%}) had an NYHA classification of IV, 6 (43{\%}) a classification of III, and 6 (43{\%}) a classification of II. At 6 months postoperatively, no patient had an NYHA classification of IV, 2 (14{\%}) had a classification of III, and 12 (86{\%}) an NYHA classification of II. Two patients had undergone cardiac transplant evaluations preoperatively and underwent successful transplantation after weight loss. Conclusion: The results of our study have shown that bariatric surgery for patients with cardiomyopathy is feasible and effective. Surgically induced weight loss results in both subjective and objective improvement in cardiac function. In addition, surgical weight loss can provide a bridge to transplantation in patients who were prohibited secondary to their morbid obesity.",
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AU - Ramani, G. V.

AU - Mathier, M. A.

AU - Schauer, P. R.

AU - Eid, G. M.

AU - Mattar, Samer

AU - Courcoulas, A. P.

AU - Ramanathan, R.

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N2 - Background: Longstanding morbid obesity can be associated with severe cardiomyopathy. However, the safety and efficacy of bariatric surgery in patients with severe cardiomyopathy has not been studied, and the effect of surgical weight loss on postoperative cardiac function is also unknown. In addition, morbidly obese patients have significantly increased mortality associated with cardiac transplantation, often precluding them from becoming recipients. Methods: A retrospective study of patients with a left ventricular ejection fraction ≤35% who underwent bariatric surgery (1998-2005) was performed. Short-term morbidity/mortality, length of stay, excess weight loss, pre- and postoperative left ventricular ejection fraction, and New York Heart Association (NYHA) functional class were assessed. Results: A total of 14 patients (10 men and 4 women) with a mean preoperative body mass index of 50.8 ± 2.04 kg/m2 underwent bariatric surgery (10 underwent laparoscopic Roux-en-Y gastric bypass, 1 open Roux-en-Y gastric bypass, 2 sleeve gastrectomy, and 1 laparoscopic gastric banding). The complications were pulmonary edema in 1, hypotension in 1, and transient renal insufficiency in 2. The median length of stay was 3.0 days (range 2-9). The mean excess weight loss at 6 months was 50.4%, with a decrease in the mean body mass index from 50.8 ± 2.04 kg/m2 to 36.8 ± 1.72 kg/m2. The mean left ventricular ejection fraction at 6 months had significantly improved from 23% ± 2% to 32% ± 4% (P = .04), correlating with improved functional capacity, as measured by the NYHA classification. Preoperatively, 2 patients (14%) had an NYHA classification of IV, 6 (43%) a classification of III, and 6 (43%) a classification of II. At 6 months postoperatively, no patient had an NYHA classification of IV, 2 (14%) had a classification of III, and 12 (86%) an NYHA classification of II. Two patients had undergone cardiac transplant evaluations preoperatively and underwent successful transplantation after weight loss. Conclusion: The results of our study have shown that bariatric surgery for patients with cardiomyopathy is feasible and effective. Surgically induced weight loss results in both subjective and objective improvement in cardiac function. In addition, surgical weight loss can provide a bridge to transplantation in patients who were prohibited secondary to their morbid obesity.

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KW - Body mass index

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