From the Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Cardiol Rev. 2022;30(1):1-7. doi: 10.1097/CRD.0000000000000346.
Class 2 obesity or greater [body mass index (BMI) >35 kg/m2] is a relative contraindication for heart transplant due to its associated perioperative risks and mortality. Whether bariatric surgery can act as a potential bridging procedure to heart transplantation is unknown. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery on improving transplant candidacy in patients with end-stage heart failure (ESHF). MEDLINE, EMBASE, CENTRAL, and PubMed databases were searched up to September 2019 for studies that performed bariatric surgery on patients with severe obesity and ESHF. Outcomes of interest included incidence of patients listed for heart transplantation after bariatric surgery, proportion of patients that successfully received transplant, the change in BMI after bariatric surgery, and 30-day complications. Pooled estimates were calculated using a random-effects meta-analysis of proportions. Eleven studies with 98 patients were included. Mean preoperative BMI was 44.9 (2.1) kg/m2 and BMI after surgery was 33.2 (2.3) kg/m2 with an absolute BMI reduction of 26.1%. After bariatric surgery, 71% [95% confidence interval (CI), 55-86%] of patients with ESHF were listed for transplantation. The mean time from bariatric surgery to receiving a heart transplant was 14.9 (4.0) months. Of the listed patients, 57% (95% CI, 39-74%) successfully received heart transplant. The rate of 30-day mortality after bariatric surgery was 0%, and the 30-day major and minor complications after bariatric surgery was 28% (95% CI, 10-49%). Bariatric surgery can facilitate sustained weight loss in obese patients with ESHF, improving heart transplant candidacy and the incidence of transplantation.
2 级肥胖或更严重（体重指数（BMI）>35kg/m2）由于其围手术期风险和死亡率较高，是心脏移植的相对禁忌症。减重手术是否可以作为心脏移植的潜在桥接手术尚不清楚。本系统评价和荟萃分析的目的是研究减重手术在改善终末期心力衰竭（ESHF）患者心脏移植候选资格方面的作用。截至 2019 年 9 月，我们在 MEDLINE、EMBASE、CENTRAL 和 PubMed 数据库中搜索了对严重肥胖和 ESHF 患者进行减重手术的研究。感兴趣的结果包括减重手术后患者被列入心脏移植名单的发生率、成功接受移植的患者比例、减重手术后 BMI 的变化以及 30 天并发症。使用随机效应荟萃分析对比例进行汇总估计。纳入了 11 项研究，共 98 名患者。术前平均 BMI 为 44.9（2.1）kg/m2，手术后 BMI 为 33.2（2.3）kg/m2，绝对 BMI 降低了 26.1%。减重手术后，71%[95%置信区间（CI），55-86%]的 ESHF 患者被列入移植名单。从减重手术到接受心脏移植的平均时间为 14.9（4.0）个月。在列出的患者中，57%（95%CI，39-74%）成功接受了心脏移植。减重手术后 30 天死亡率为 0%，减重手术后 30 天主要和次要并发症发生率为 28%（95%CI，10-49%）。减重手术可以使 ESHF 肥胖患者持续减重，改善心脏移植候选资格和移植发生率。
