Drexel University College of Medicine, Philadelphia, PA, USA.
Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Obes Surg. 2020 Nov;30(11):4437-4445. doi: 10.1007/s11695-020-04834-4. Epub 2020 Jul 11.
A body mass index (BMI) > 35 kg/m is a relative contraindication to heart transplantation in patients with end-stage heart failure. Bariatric surgery can be considered either concomitantly with continuous-flow left ventricular assist device (CF-LVAD) placement, or staged after CF-LVAD has been placed. We sought to evaluate the outcomes of these approaches.
An electronic search was performed to identify all relevant studies. After assessment for inclusion and exclusion criteria, eight studies were pooled for systematic review and metaanalysis.
Overall, of 59 patients, 22 (37%) underwent simultaneous sleeve gastrectomy with CF-LVAD implantation while 37 (63%) underwent staged sleeve gastrectomy after CF-LVAD. The mean age of patients was 46 years (95% CI: 39-53) with 40% females. Mean BMI at most recent follow-up (33.4 kg/m, 95% CI: 30.2-36.6) was significantly lower compared with mean preoperative BMI (46.7 kg/m, 95% CI: 42.9-50.6) (p < 0.01). There was no significant difference in total incidence of postoperative complications (simultaneous, 16% (95% CI: 1-87%) versus staged, 23% (95% CI: 7-53%)) or in overall survival (simultaneous, 93% (95% CI: 72-99%) versus staged, 79% (95% CI: 60-90%), p = 0.17) for average follow-up time of 12.7 months. Bariatric surgery resulted in 66% of patients (95% CI: 51-79) to be listed for heart transplantation, including 33% (95% CI: 22-47) who were transplanted.
Both simultaneous and staged bariatric surgeries with CF-LVAD placement have comparable outcomes and significantly reduce BMI. This can allow previously ineligible patients to undergo heart transplantation.
体重指数（BMI）>35kg/m²是心力衰竭终末期患者心脏移植的相对禁忌症。减重手术可以与连续流左心室辅助装置（CF-LVAD）同时进行，也可以在 CF-LVAD 放置后分期进行。我们旨在评估这些方法的结果。
进行了电子检索以确定所有相关研究。在评估纳入和排除标准后，有 8 项研究被汇总进行系统评价和荟萃分析。
总体而言，在 59 名患者中，22 名（37%）同时接受袖状胃切除术和 CF-LVAD 植入，37 名（63%）在 CF-LVAD 后分期接受袖状胃切除术。患者的平均年龄为 46 岁（95%CI：39-53），女性占 40%。最近随访时的平均 BMI（33.4kg/m，95%CI：30.2-36.6）明显低于术前平均 BMI（46.7kg/m，95%CI：42.9-50.6）（p<0.01）。术后总并发症发生率无显著差异（同期，16%（95%CI：1-87%）与分期，23%（95%CI：7-53%））或总生存率（同期，93%（95%CI：72-99%）与分期，79%（95%CI：60-90%），p=0.17），平均随访时间为 12.7 个月。减重手术后，66%的患者（95%CI：51-79）被列入心脏移植名单，其中 33%（95%CI：22-47）接受了移植。
同时进行减重手术和 CF-LVAD 放置以及分期手术的效果相当，且显著降低 BMI。这可以使以前不符合条件的患者接受心脏移植。
