AI Article Synopsis

  • - Obese patients with congestive heart failure (CHF) often face restrictions on heart transplantation based on achieving a specific BMI, making it unclear if rapid weight loss from bariatric surgery can improve waitlist placement and survival rates.
  • - A decision analysis model evaluated life expectancy for morbidly obese patients (BMI of 45 kg/m) undergoing medical weight management (MWM), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG), finding RYGB to significantly improve both transplantation rates and overall survival.
  • - The study concluded that bariatric surgery increases access to heart transplants and enhances long-term survival compared to MWM, suggesting morbidly obese CHF patients should consider surgical options and have

Article Abstract

Introduction: Obese patients with congestive heart failure (CHF) are often denied access to heart transplantation until they obtain significant weight loss to achieve a certain BMI threshold, often less than 35 kg/m. It is unknown whether the rapid weight loss associated with bariatric surgery leads to improved waitlist placement, and as such improved survival for morbidly obese patients with CHF.

Methods: A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with CHF who were deemed ineligible to be waitlisted for heart transplantation unless they achieved a BMI less than 35 kg/m. Life expectancy following medical weight management (MWM), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) was estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review.

Results: RYGB improved survival compared with both SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 2.1 additional years of life compared with patient's who underwent SG and 7.4 additional years of life compared with MWM. SG patients gained 5.3 years of life compared with MWM.

Conclusions: When strict waitlist criteria were applied, bariatric surgery improved access to heart transplantation and thereby increased long-term survival compared with MWM. Morbidly obese CHF patients who anticipate need for heart transplantation should be encouraged to pursue surgical weight management strategies, necessitating discussion between bariatric surgeons, cardiologists, and cardiac surgeons for appropriate perioperative risk management.

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Source
http://dx.doi.org/10.1007/s11605-020-04587-6DOI Listing

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