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曾接受心脏血运重建术患者的减重手术:文献综述

Bariatric Surgery in Patients with Previous Cardiac Revascularization: Review of Literature.

作者信息

Bandea Dan, Vilallonga Ramon, Nedelcu Anamaria, Gavril Laura Gabriela, Nedelcu Marius, Suciu Bogdan Andrei

机构信息

Onesti Municipal Hospital, 601048 Onesti, Romania.

George Emil Palade University of Medicine, Pharmacy, Science and Technology of Tîrgu Mureș, 540142 Tîrgu Mureș, Romania.

出版信息

J Clin Med. 2024 Aug 14;13(16):4779. doi: 10.3390/jcm13164779.

Abstract

: The diet and physical activity of the world's population determine the increase in the number of bariatric surgeries. The most common types of bariatric surgery are laparoscopic sleeve gastrectomy (LSG) and Roux-Y gastric bypass (RYGB). Surgical interventions are carried out in patients with numerous comorbidities, among which the most common are cardiovascular diseases. The aim of the present study was to review the literature regarding the safety and results of surgical treatment in patients with cardiac revascularization prior to surgery. : We performed an online search in Pubmed in September 2023 to identify articles that reported cardiac revascularization prior to bariatric surgery. The extracted information included details of the working method, number of patients, types of cardiovascular disease-heart failure (HF) and cardiac artery disease (CAD), types of revascularization-coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or both CABG + PCI, demographic data (age, gender, race), clinical characteristics (body mass index-BMI, smoking status), comorbidities (diabetes mellitus, hypertension, prior myocardial infarction), postoperative complications, and postoperative results. : A total of 171 records were identified by the initial search, and 165 papers were excluded after applying the exclusion criteria (types of cardiovascular disease, types of revascularization, and demographic data). We evaluated a group of 9479 patients of which 730 had HF, 2621 CAD, and 1426 underwent prior cardiac revascularization. The analysis of the demographic data showed an average age of 55.5 years and a fluctuation of the male gender between 39% and 71.1%, and the female gender between 28.9% and 61%. The main types of bariatric interventions were RYGB (3659 cases) and LSG (659 cases), to which adjustable gastric band (AGB) and bilio-pancreatic diversion-duodenal switch (BPD-DS) were added. Among the most postprocedural complications were ST-segment elevation myocardial infarction (2 patients), gastro-intestinal bleeding (51 cases), pulmonary embolism (1 patient), arrhythmia (3 patients) and pacemaker insertion (1 patient). The recorded postoperative mortality rate was 0.42% (6 cases). : Bariatric surgery remains safe in patients with cardiac revascularization. These finding need to be confirmed in more large-scale randomized trials.

摘要

全球人口的饮食和身体活动决定了减肥手术数量的增加。最常见的减肥手术类型是腹腔镜袖状胃切除术(LSG)和Roux-Y胃旁路术(RYGB)。手术干预针对患有多种合并症的患者进行,其中最常见的是心血管疾病。本研究的目的是回顾关于术前进行心脏血运重建的患者手术治疗安全性和结果的文献。

我们于2023年9月在PubMed上进行了在线搜索,以识别报告减肥手术前进行心脏血运重建的文章。提取的信息包括工作方法细节、患者数量、心血管疾病类型——心力衰竭(HF)和冠状动脉疾病(CAD)、血运重建类型——冠状动脉旁路移植术(CABG)、经皮冠状动脉介入治疗(PCI)或CABG + PCI两者、人口统计学数据(年龄、性别、种族)、临床特征(体重指数——BMI、吸烟状况)、合并症(糖尿病、高血压、既往心肌梗死)、术后并发症和术后结果。

初步搜索共识别出171条记录,应用排除标准(心血管疾病类型、血运重建类型和人口统计学数据)后排除165篇论文。我们评估了一组9479例患者,其中730例患有HF,2621例患有CAD,1426例曾接受过心脏血运重建。人口统计学数据分析显示平均年龄为55.5岁,男性比例在39%至71.1%之间波动,女性比例在28.9%至61%之间波动。减肥手术的主要类型是RYGB(3659例)和LSG(659例),此外还有可调节胃束带术(AGB)和胆胰转流十二指肠转位术(BPD-DS)。术后最常见的并发症包括ST段抬高型心肌梗死(2例患者)、胃肠道出血(51例)、肺栓塞(1例患者)、心律失常(3例患者)和起搏器植入(1例患者)。记录的术后死亡率为0.42%(6例)。

对于已进行心脏血运重建的患者,减肥手术仍然是安全的。这些发现需要在更多大规模随机试验中得到证实。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/68dc/11355359/180f103d0a1d/jcm-13-04779-g001.jpg

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