A172 The Role of Bariatric Surgery in Patients with Obesity and Advanced Heart Failure as a Bridge to Heart Transplantation: A Systematic Review and Meta-Analysis

Introduction: Obesity (body mass index [BMI] >35 kg/m2) remains a relative contraindication for kidney transplant, while patients after kidney transplantation (KTX) are predisposed to obesity. The present study aims to investigate the role of bariatric surgery in improving transplant candidacy in patients prior to KTX, as well its safety and efficacy in KTX patients postoperatively. Methods: A systematic search was conducted up to March 2020. Both comparative and non-comparative studies investigating the role of bariatric surgery before or after KTX were considered. Outcomes included change in BMI, rates of mortality and complications, and the rate of patients who underwent KTX following bariatric surgery. Pooled estimates were calculated using the random effects meta-analysis of proportions. Results: Twenty-one studies were eligible for final review; 11 studies investigated the role of bariatric surgery before KTX. The weighted mean BMI was 43.4 (5.7) kg/m2 at baseline and 33.9 (6.3) kg/m2 at 29.1 months followup. After bariatric surgery, 83% (95% confidence interval [CI] 57–99) were successfully listed for KTX and 83% (95% CI 65–97) patients subsequently received successful KTX. Ten studies investigated the role of bariatric surgery after kidney transplant. Weighted mean baseline BMI was 43.8 (2.2) kg/m2 and mean BMI at 19.5 months followup was 34.2 (6.7) kg/m2. Overall, all-cause 30-day mortality was 0.5% for both those who underwent bariatric surgery before or after receiving a KTX. The results of this study are limited by the inclusion of only non-randomized studies, limited followup, and high heterogeneity. Conclusions: Bariatric surgery may be safe and effective in reducing weight to improve KTX candidacy in patients with severe obesity and can also be used safely following KTX.

Download Full-text

2458The role of statins in patients with heart failure with preserved, mid-range and reduced ejection fraction; a meta-analysis and systematic review

European Heart Journal ◽

10.1093/eurheartj/ehy565.2458 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

A Bielecka-Dabrowa ◽

I Bytyci ◽

S Von Haehling ◽

J Jozwiak ◽

J Rysz ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Ejection Fraction ◽

Meta Analysis ◽

Reduced Ejection Fraction ◽

Patients With Heart Failure

Download Full-text

Bariatric surgery among patients with heart failure: a systematic review and meta-analysis

Open Heart ◽

10.1136/openhrt-2018-000910 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000910 ◽

Cited By ~ 6

Author(s):

Sebastian Berger ◽

Pascal Meyre ◽

Steffen Blum ◽

Stefanie Aeschbacher ◽

Marco Ruegg ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Bariatric Surgery ◽

Surgical Treatment ◽

Meta Analysis ◽

Randomised Trial ◽

Left Ventricular Ejection ◽

Obese Patients ◽

Non Surgical Treatment ◽

New Onset

BackgroundBariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF.MethodsWe performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery.ResultsWe found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively.ConclusionIn this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF.

Download Full-text

Abstract 16355: Impact of Renal Dysfunction on Outcomes After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.16355 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Michel Ibrahim ◽

Sandrine Lebrun ◽

Garly Rushler Saint Croix ◽

Michael Fattouh ◽

Sandra V Chaparro

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Renal Dysfunction ◽

Meta Analysis ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Assist Device ◽

Ventricular Assist ◽

Left Ventricular Assist ◽

All Cause Mortality

Background: Renal dysfunction is a common comorbidity in patients with advanced heart failure who may benefit from left ventricular assist device (LVAD) therapy. The effect of preoperative renal dysfunction on clinical outcomes after LVAD implantation remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes post-LVAD in patients with and without renal dysfunction. Methods: PubMed, Medline, and EMBASE databases were searched for studies comparing outcomes in patients with and without renal dysfunction who underwent LVAD implantation for advanced heart failure. The primary outcome of all-cause mortality was reported as random effects risk ratio (RR) with 95% confidence interval. Results: Our search yielded 5,229 potentially eligible studies. We included 7 studies reporting on 26,652 patients. Patients with renal dysfunction (glomerular filtration rate (GFR) <60) (n=4,630) were found to have increased risk of all-cause mortality 2.21 (95% CI 1.39-3.51, p <0.01) when compared to patients with normal renal function (GFR >60) (n=22,019). Conclusion: Patients with renal dysfunction have increased mortality after LVAD implantation when compared to patients with normal renal function. GFR can be used to risk stratify patients and guide decision making prior to LVAD therapy.

Download Full-text