Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/77880
Title: Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis
Authors: Da Silva De Abreu, Adrian Jose 
ALHAFEZ, BADER ALDEEN
CURBELO-PENA, YUHAMY
LAVIE, CARL J.
VENTURA, HECTOR O.
Loro Ferrer, Juan Francisco 
MANDRAS, STACY A.
UNESCO Clasification: 32 Ciencias médicas
3213 Cirugía
Keywords: Bariatric Surgery
Heart Transplantation
Laparoscopic Roux-En-Y Gastric Bypass
Laparoscopic Sleeve Gastrectomy
Obesity, et al
Issue Date: 2021
Journal: Journal of Cardiac Failure 
Abstract: Background: Class II obesity (body mass index BMI ≥35 kg/m2) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging. Methods and Results: We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m2 and decreased significantly during follow-up (rho –0.671; P< .00001). Among 23 patients with documented listing status, 78.3% got listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12–30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m2/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3–17 months). Patients with a BMI<45 kg/m2 had a higher chance of achieving the composite outcome (P< .003). Conclusions: BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.
URI: http://hdl.handle.net/10553/77880
ISSN: 1071-9164
DOI: 10.1016/j.cardfail.2020.12.011
Source: Journal of Cardiac Failure[ISSN 1071-9164], (Enero 2021)
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