John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana; The University of Queensland Ochsner Clinical School, New Orleans, Louisiana; Doctoral School, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain.
Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
J Card Fail. 2021 Mar;27(3):338-348. doi: 10.1016/j.cardfail.2020.12.011. Epub 2020 Dec 25.
Class II obesity (body mass index BMI ≥35 kg/m) is a contraindication to heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices, low sample sizes have made their analysis and interpretation challenging.
We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every ventricular assist device patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured. Fourteen references with 29 patients were included. The mean age was 41.9 ± 12.2 years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. The mean pre-BS BMI was 45.5 ± 6.6 kg/m and decreased significantly during follow-up (rho -0.671; P< .00001). Among 23 patients with documented listing status, 78.3% were listed for HT. Thirteen of 28 patients (46.4%) underwent HT at 14.4 ± 7.0 months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 months (interquartile range, 12-30 months). Twenty-two of 28 patients (78.6%) achieved the composite outcome (BMI of<35 kg/m/HT/listing for HT/myocardial recovery) at 11 months (interquartile range, 3-17 months). Patients with a BMI<45 kg/m had a higher chance of achieving the composite outcome (P< .003).
BS may help patients with obesity and ventricular assist devices to lose a significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.
二级肥胖症（体重指数 BMI≥35kg/m）是心脏移植（HT）的禁忌症。尽管少数单中心研究（病例报告/系列和小队列）报告了肥胖症和心室辅助设备患者接受减肥手术（BS）的有希望的结果，但由于样本量小，使得对这些研究的分析和解释变得具有挑战性。
我们在 ClinicalTrials.gov、Cochrane、Embase、PubMed、Google Scholar 和大多数相关的减肥和心力衰竭期刊中进行了系统检索。我们提取了每例接受 BS 治疗的心室辅助设备患者的基线和结局个体参与者数据，并报告了术后 BMI 及其各自的 BMI 数据测量时间点。共纳入 14 篇参考文献，涉及 29 例患者。患者的平均年龄为 41.9±12.2 岁，82.8%接受了腹腔镜袖状胃切除术，39.3%报告了围手术期不良事件。BS 前的平均 BMI 为 45.5±6.6kg/m，在随访期间显著下降（rho=-0.671；P<.00001）。在 23 例有记录的列表状态患者中，78.3%被列入 HT 列表。28 例患者中有 13 例（46.4%）在 14.4±7.0 个月后接受 HT。HT 无死亡的 1 年期间无报告死亡。中位随访时间为 24 个月（四分位间距，12-30 个月）。28 例患者中有 22 例（78.6%）在 11 个月（四分位间距，3-17 个月）时达到复合终点（BMI<35kg/m/HT/列入 HT 列表/心肌恢复）。BMI<45kg/m 的患者更有可能达到复合终点（P<.003）。
BS 可能有助于肥胖症和心室辅助设备患者减轻大量体重，并提高他们接受 HT 的候选资格，甚至实现心肌恢复。
