Abstract
Background
Young severely obese patients with advanced heart failure may not be suitable candidates
for cardiac transplantation because of surgical morbidity and availability of adequately
sized donor hearts.
Methods and Results
We report 2 patients with severe systolic dysfunction and Class IV heart failure despite
maximal medical therapy who were considered for cardiac transplantation. Because of
their severe obesity, transplantation was not considered an optimal therapy, and both
were referred for bariatric surgery. The individuals had nonischemic cardiomyopathy.
Both underwent laparoscopic vertical gastrectomy, minimizing surgical risk while providing
definitive reduction in gastric volume. They experienced substantial weight loss and
resolution of dyspnea. Inotrope infusion was discontinued in 1 dobutamine-dependent
individual. They achieved weight reduction of 46 to 52 kg after the surgery. End-systolic
volume index improved from 64 to 49 mL/m2 and from 66 to 39 mL/m2. Left ventricular ejection fraction improved from 20% to 45% and from 25% to 39%.
They remain symptom-free and are no longer listed for transplant at 2 years' follow-up.
Conclusions
Bariatric surgery may lead to improvement in left ventricular systolic dysfunction
in young morbidly obese individuals with nonischemic cardiomyopathy. Potential explanations
for the improvement in left ventricular function include reduced direct toxic effects
of adiposity on cardiomyocytes and improved hemodynamics after weight loss. The potential
for bariatric surgery to provide an alternative to heart transplantation in extreme
obesity merits further study.
Key Words
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Article info
Publication history
Accepted:
December 18,
2007
Received in revised form:
December 9,
2007
Received:
July 21,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
