Sleeve gastrectomy as a bridge to cardiac recovery - A retrospective comparative cohort study

JHLT Open Pub Date : 2025-02-07 DOI:10.1016/j.jhlto.2025.100224

Thomas Goubar MD , Samuel Kim MD , David Cistulli MD , Douglas Fenton-Lee MBBS , R. Louise Rushworth PhD , Peter S. Macdonald MD, PHD , Anne M. Keogh MBBS

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引用次数: 0

Abstract

Background

Obesity in patients with heart failure with reduced ejection fraction (HFrEF) increases morbidity and may preclude them from accessing advanced heart failure therapies. Bariatric surgery, specifically sleeve gastrectomy (SG), may improve eligibility for cardiac transplant; however, its impact on heart failure outcomes is not well defined.

Methods

We conducted a retrospective cohort study of patients with obesity (body mass index [BMI] ≥35 kg/m²) and (left ventricular ejection fraction [LVEF] ≤40%) who underwent SG at a tertiary heart transplant center. Outcomes were compared with controls matched for age, sex, LVEF, and BMI receiving standard care. We evaluated BMI, New York Heart Association (NYHA) functional class, medications, echocardiographic parameters, time to advanced heart failure therapies, and survival.

Results

Twenty patients (median BMI 42.8 kg/m², LVEF 25%) underwent SG compared to 40 matched patients. Both groups demonstrated reductions in BMI; however, weight loss was significantly greater in the treatment group (−9.9 [95% CI −12.2, −7.6] vs. −2.7 [−4.3, −1.1] kg/m², p < 0.05). Despite this, improvements in LVEF (+16.6% [10.2, 23.0] vs. +0.1% [−4.4, 4.7], p < 0.05) along with NYHA class (−0.8 [95% CI: −1.3, −0.3] vs. +0.4 [0.1, 0.7], p < 0.05) were only observed in those receiving SG. Overall survival was significantly higher in the treatment group [HR: 0.2 (0.07, 0.62), p < 0.01], which had no deaths compared to 35% in the comparison group.

Conclusion

In patients with HFrEF and obesity, SG is associated with significant improvements in cardiac function and survival compared to standard care, supporting its role as a safe and effective bridge to recovery or candidacy.

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袖式胃切除术作为心脏恢复的桥梁-一项回顾性比较队列研究

背景：心力衰竭伴射血分数降低（HFrEF）患者的肥胖增加了发病率，并可能使他们无法获得先进的心力衰竭治疗。减肥手术，特别是袖胃切除术（SG），可以提高心脏移植的资格；然而，它对心力衰竭结果的影响还没有很好的定义。方法对在三级心脏移植中心接受SG治疗的肥胖（体重指数[BMI]≥35 kg/m2）和（左室射血分数[LVEF]≤40%）患者进行回顾性队列研究。结果与接受标准治疗的年龄、性别、LVEF和BMI相匹配的对照组进行比较。我们评估了BMI、纽约心脏协会（NYHA）功能分级、药物、超声心动图参数、晚期心力衰竭治疗时间和生存率。结果20例患者（中位BMI 42.8 kg/m²，LVEF 25%）接受了SG治疗，而40例匹配患者接受了SG治疗。两组均表现出BMI下降；然而，治疗组的体重减轻明显更大(- 9.9 [95% CI - 12.2, - 7.6] vs. - 2.7 [- 4.3, - 1.1] kg/m²，p <；0.05)。尽管如此，LVEF的改善(+16.6% [10.2,23.0]vs +0.1% [- 4.4, 4.7], p <；0.05)随着NYHA类(−0.8(95%置信区间CI:−1.3−0.3)和+ 0.4 [0.1,0.7],p & lt;0.05)，仅在接受SG治疗的患者中观察到。治疗组总生存率显著高于对照组[HR: 0.2 (0.07, 0.62), p <；0.01]，无死亡，而对照组为35%。结论：在HFrEF和肥胖患者中，与标准治疗相比，SG与心功能和生存的显著改善相关，支持其作为安全有效的康复或候选桥梁的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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