Class 3 obesity or greater (BMI >35 kg/m2) is a relative contraindication for heart transplant due to its perioperative risk and mortality. Bariatric surgery has been explored as a potential bridging procedure to transplant by facilitating weight loss and improving cardiac function. The aim of this systematic review and meta-analysis is to investigate the role of bariatric surgery on improving transplant candidacy in patients with ESHF.
MEDLINE, EMBASE, CENTRAL, and PubMed databases were searched up to February 2019 for studies that performed bariatric surgery on patients with severe obesity and ESHF. Key outcomes included rate of patients listed for heart transplantation after bariatric surgery, rate of patients subsequently receiving transplant, change in BMI after bariatric surgery, 30-day complications. Pooled estimates were calculated using the random effects meta-analysis of proportions. MINORS tool was used to assess quality of evidence.
10 studies with 92 patients were included. Mean (SD) preoperative BMI was 45.1 (5.1) kg/m2 and BMI after surgery was 33.8 (4.0) kg/m2 with absolute BMI loss of 25.1%. After bariatric surgery, 69% (95%CI, 48%-88%) of patients with ESHF were listed for transplantation. Time to bariatric surgery to receiving heart transplant was 12 (13-20.5) months. Of the listed patients, 67% (95%CI, 45-86%) successfully received a heart transplant. The rate of 30-day bariatric surgery-related complications was 18% (95%CI 6%-33%) and rate of 30-day mortality after bariatric surgery was 0%
Bariatric surgery can facilitate sustained weight loss in obese patients with ESHF, thus improving heart transplant candidacy and transplantation.