Impact of Laparoscopic Sleeve Gastrectomy on Pulmonary Arterial Stiffness and Right Ventricular Function in Obese Patients.

Introduction: Pulmonary hypertension (PH) is a serious condition associated with high morbidity and mortality, with obesity identified as a significant risk factor. Pulmonary arterial stiffness (PAS) is an early marker of PH, often preceding clinical symptoms. While laparoscopic sleeve gastrectomy (LSG) has been shown to improve various cardiac parameters in obese patients, its impact on PAS and right ventricular (RV) function in the absence of PH remains unclear. This study investigates the effects of LSG on PAS and RV function in obese patients without pre-existing PH.

Methods: A cohort of 54 patients with obesity who underwent LSG between January and June 2023 at the University hospital was prospectively studied. Patients were evaluated preoperatively and six months postoperatively using comprehensive echocardiographic assessments. Key parameters measured included tricuspid annular systolic velocity (TAS), tricuspid regurgitation velocity (TRV), pulmonary flow acceleration time (PFAT), pulmonary artery velocity, and PAS. Statistical analyses were conducted using paired t-tests and the Wilcoxon signed-rank test.

Results: Significant improvements were observed in several echocardiographic and hemodynamic parameters post-LSG. PAS showed a notable reduction from 2.44 ± 0.68 preoperatively to 1.74 ± 0.32 postoperatively (p < 0.001). Additionally, significant decreases were observed in TRV (2.00 ± 0.30 m/sec to 1.79 ± 0.40 m/sec, p = 0.025) and systolic pulmonary artery pressure (SPAP) (21.28 ± 4.69 mmHg to 18.36 ± 5.28 mmHg, p = 0.025). Improvements in RV function were indicated by an increase in tricuspid annular plane systolic excursion (TAPSE) from 17.68 ± 4.17 mm preoperatively to 21.18 ± 3.53 mm postoperatively (p < 0.001).

Conclusions: LSG significantly reduces PAS and improves RV function in obese patients, even in the absence of PH. These findings suggest that LSG may offer protective effects on pulmonary vascular health, highlighting its potential as a therapeutic intervention for reducing PH risk in obese patients. Further research is warranted to explore the long-term cardiovascular benefits of LSG in diverse populations.