Obesity and advanced heart failure, can bariatric surgery help?
Joint Event on International Conference on Molecular Biology, Tissue Science and Regenerative Medicine & 4th World Heart Congress
November 19-20, 2018 | Paris, France
Jeffrey E Friedman
University of Florida, USA
Keynote : Biomed Res
Background: Obesity is associated with heart failure due to structural and functional changes within the heart. Obesity increases metabolic demand, total blood volume and stroke volume. Thiscausesleftventriculardilatation, cardiachypertrophy and atrial enlargement. Definitive treatment for severe heart failure is cardiac transplantation. Transplantation is not an option for patients with a BMI over 35 kg/m2. Bariatric surgery is the most effective means of sustained weight loss when diet and exercise fail, however there are very few reports of weight loss surgery in patients with advanced heart failure in the literature. Methods: Thirteen morbidly obese patients with end stage heart failure with left ventricular assist device (LVAD) in place that underwent LSG between 2013 and 2018, were reviewed retrospectively. All thirteen patients suffered from severe advanced heart failure requiring left ventricular assist device support. Bariatric, cardiac and renal parameters, operative and postoperative complications, comorbidities and United Nation of Organ Sharing (UNOS) transplant candidacy status were analyzed. Results: 6 of the 13 patients achieved adequate weight loss with a BMI under 35 and received a heart transplantation. 5 of the 13 patients achieved adequate weight loss with a BMI under 35 and are listed for transplantation with status 1B. 2 of the 13 patients achieved adequate weight loss and had significant improvement in ejection fraction and are currently under evaluation for removal of their LVAD. Conclusion: Advanced heart failure requiring LVAD support in association with obesity is a difficult problem, sleeve gastrectomy can be safely utilized in patients with end-stage heart failure and morbid obesity in order to achieve weight loss to become eligible for transplant listing.
Jeffrey E Friedman is as an assistant professor in the division of general surgery and the director of bariatric surgery. He earned his medical degree from the University of Mississippi and completed his residency in general surgery at Carraway Methodist Medical Center in Birmingham, Alabama and Mary Imogene Bassett Healthcare in Cooperstown, New York. He served as a research fellow at the Mary Imogene Bassett Research Institute and as a minimally invasive surgery/bariatric surgery fellow at Sacred Heart Health System in Pensacola, Florida. He has previously worked as assistant medical director of the Sacred Heart Institute for Medical Weight Loss, as medical director of the Baptist Healthcare Bariatric Program in Pensacola and as chief of the minimally invasive surgery/bariatric program at Previty Clinic for Surgical Care in Beaumont, Texas. He has twice received the American Medical Association’s Physician’s Recognition Award and is a member of the American College of Surgeons, the Society of American Gastrointestinal and Endoscopic Surgeons, the Pensacola Surgical Society and the American Society of Metabolic and Bariatric Surgeons.
E-mail: [email protected]