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Safety of Bariatric Surgery in Obese Patients With Hypertrophic Cardiomyopathy

Published:January 03, 2022DOI:https://doi.org/10.1016/j.amjcard.2021.11.055
      Obesity is an independent risk factor for heart failure in patients with hypertrophic cardiomyopathy (HC). In this study, we examined national trends and early outcomes of bariatric surgery for obesity in patients with HC. Using the weighted discharge data from the National Inpatient Sample, we identified adult patients with HC who underwent elective bariatric surgery for obesity between 2011 and 2017. A total of 443 obese patients with HC were identified, and 42% (n = 185) had obstructive HC. The annual number of patients increased from 18 in 2011 to 130 in 2017. Overall, the median (interquartile range) age was 50 (43 to 57) years, and 85 patients (19%) were 60 years or older. Approximately 20% (n = 90) of the patients had heart failure at the time of operation. Atrial fibrillation was present in 83 patients (19%), and 22% (n = 95) of the cohort had a pacemaker or automatic cardiac defibrillator implanted before the operation. Laparoscopic sleeve gastrectomy (72%, n = 318) and laparoscopic Roux-en-Y gastric bypass (25%, n = 110) were the most commonly performed bariatric procedures. Overall, patients stayed in the hospital for a median (interquartile range) of 2 (1 to 2) days. During the hospital stay, there were no deaths, myocardial infarctions, or documented episodes of thromboembolism. In conclusion, bariatric surgery in patients with HC is performed more frequently in recent years and is safe and associated with few perioperative complications. Because of the impact of obesity on long-term survival, clinicians should strongly consider bariatric surgery for obese HC patients who do not respond to conservative weight loss measures.
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      References

        • Moussa O
        • Ardissino M
        • Heaton T
        • Tang A
        • Khan O
        • Ziprin P
        • Darzi A
        • Collins P
        • Purkayastha S.
        Effect of bariatric surgery on long-term cardiovascular outcomes: a nationwide nested cohort study.
        Eur Heart J. 2020; 41: 2660-2667
        • Powell-Wiley TM
        • Poirier P
        • Burke LE
        • Després JP
        • Gordon-Larsen P
        • Lavie CJ
        • Lear SA
        • Ndumele CE
        • Neeland IJ
        • Sanders P
        • St-Onge MP
        American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. Obesity and cardiovascular disease: a scientific statement from the American Heart Association.
        Circulation. 2021; 143: e984-e1010
        • Doumouras AG
        • Wong JA
        • Paterson JM
        • Lee Y
        • Sivapathasundaram B
        • Tarride JE
        • Thabane L
        • Hong D
        • Yusuf S
        • Anvari M.
        Bariatric surgery and cardiovascular outcomes in patients with obesity and cardiovascular disease: a population-based retrospective cohort study.
        Circulation. 2021; 143: 1468-1480
        • Campos GM
        • Khoraki J
        • Browning MG
        • Pessoa BM
        • Mazzini GS
        • Wolfe L.
        Changes in utilization of bariatric surgery in the United States From 1993 to 2016.
        Ann Surg. 2020; 271: 201-209
        • Worni M
        • Østbye T
        • Shah A
        • Carvalho E
        • Schudel IM
        • Shin JH
        • Pietrobon R
        • Guller U.
        High risks for adverse outcomes after gastric bypass surgery following failed gastric banding: a population-based trend analysis of the United States.
        Ann Surg. 2013; 257: 279-286
        • Nguyen T
        • Alzahrani T
        • Mandler A
        • Alarfaj M
        • Panjrath G
        • Krepp J.
        Relation of bariatric surgery to inpatient cardiovascular outcomes (from the National Inpatient Sample).
        Am J Cardiol. 2021; 144: 143-147
        • Quan H
        • Sundararajan V
        • Halfon P
        • Fong A
        • Burnand B
        • Luthi JC
        • Saunders LD
        • Beck CA
        • Feasby TE
        • Ghali WA.
        Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data.
        Med Care. 2005; 43: 1130-1139
        • Chang SH
        • Stoll CR
        • Song J
        • Varela JE
        • Eagon CJ
        • Colditz GA.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003–2012.
        JAMA Surg. 2014; 149: 275-287
        • English WJ
        • DeMaria EJ
        • Hutter MM
        • Kothari SN
        • Mattar SG
        • Brethauer SA
        • Morton JM.
        American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States.
        Surg Obes Relat Dis. 2020; 16: 457-463
        • Kumar SB
        • Hamilton BC
        • Wood SG
        • Rogers SJ
        • Carter JT
        • Lin MY.
        Is laparoscopic sleeve gastrectomy safer than laparoscopic gastric bypass? a comparison of 30-day complications using the MBSAQIP data registry.
        Surg Obes Relat Dis. 2018; 14: 264-269
        • Olivotto I
        • Maron BJ
        • Tomberli B
        • Appelbaum E
        • Salton C
        • Haas TS
        • Gibson CM
        • Nistri S
        • Servettini E
        • Chan RH
        • Udelson JE
        • Lesser JR
        • Cecchi F
        • Manning WJ
        • Maron MS.
        Obesity and its association to phenotype and clinical course in hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2013; 62: 449-457
        • Fumagalli C
        • Maurizi N
        • Day SM
        • Ashley EA
        • Michels M
        • Colan SD
        • Jacoby D
        • Marchionni N
        • Vincent-Tompkins J
        • Ho CY
        • Olivotto I
        • Investigators SHARE
        Association of obesity with adverse long-term outcomes in hypertrophic cardiomyopathy.
        JAMA Cardiol. 2020; 5: 65-72
        • Mechanick JI
        • Apovian C
        • Brethauer S
        • Garvey WT
        • Joffe AM
        • Kim J
        • Kushner RF
        • Lindquist R
        • Pessah-Pollack R
        • Seger J
        • Urman RD
        • Adams S
        • Cleek JB
        • Correa R
        • Figaro MK
        • Flanders K
        • Grams J
        • Hurley DL
        • Kothari S
        • Seger MV
        • Still CD.
        Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures −2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists.
        Surg Obes Relat Dis. 2020; 16: 175-247
        • Nguyen NT
        • Masoomi H
        • Laugenour K
        • Sanaiha Y
        • Reavis KM
        • Mills SD
        • Stamos MJ.
        Predictive factors of mortality in bariatric surgery: data from the Nationwide Inpatient Sample.
        Surgery. 2011; 150: 347-351
        • Shimada YJ
        • Tsugawa Y
        • Brown DFM
        • Hasegawa K.
        Bariatric surgery and emergency department visits and hospitalizations for heart failure exacerbation: population-based, self-controlled series.
        J Am Coll Cardiol. 2016; 67: 895-903
        • Aleassa EM
        • Khorgami Z
        • Kindel TL
        • Tu C
        • Tang WHW
        • Schauer PR
        • Brethauer SA
        • Aminian A.
        Impact of bariatric surgery on heart failure mortality.
        Surg Obes Relat Dis. 2019; 15: 1189-1196
        • Koshino Y
        • Villarraga HR
        • Somers VK
        • Miranda WR
        • Garza CA
        • Hsiao JF
        • Yu Y
        • Saleh HK
        • Lopez-Jimenez F.
        Changes in myocardial mechanics in patients with obesity following major weight loss after bariatric surgery.
        Obesity (Silver Spring). 2013; 21: 1111-1118
        • Haering JM
        • Comunale ME
        • Parker RA
        • Lowenstein E
        • Douglas PS
        • Krumholz HM
        • Manning WJ.
        Cardiac risk of noncardiac surgery in patients with asymmetric septal hypertrophy.
        Anesthesiology. 1996; 85: 254-259
        • Davies MR
        • Cousins J.
        Cardiomyopathy and anaesthesia.
        Contin Educ Anaesth Crit Care Pain. 2009; 9: 189-193
        • Thompson RC
        • Liberthson RR
        • Lowenstein E.
        Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy.
        JAMA. 1985; 254: 2419-2421
        • Gebhart A
        • Young MT
        • Nguyen NT.
        Bariatric surgery in the elderly: 2009–2013.
        Surg Obes Relat Dis. 2015; 11: 393-398
        • Flum DR
        • Salem L
        • Elrod JA
        • Dellinger EP
        • Cheadle A
        • Chan L.
        Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures.
        JAMA. 2005; 294: 1903-1908
        • Sugerman HJ
        • DeMaria EJ
        • Kellum JM
        • Sugerman EL
        • Meador JG
        • Wolfe LG.
        Effects of bariatric surgery in older patients.
        Ann Surg. 2004; 240: 243-247
        • Flum DR
        • Belle SH
        • King WC
        • Wahed AS
        • Berk P
        • Chapman W
        • Pories W
        • Courcoulas A
        • McCloskey C
        • Mitchell J
        • Patterson E
        • Pomp A
        • Staten MA
        • Yanovski SZ
        • Thirlby R
        • Wolfe B.
        • Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
        Perioperative safety in the longitudinal assessment of bariatric surgery.
        N Engl J Med. 2009; 361: 445-454