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The researchers found that among obese individua ls with a signif icant histor y of major cardiac events, bariatric surger y led to a substa ntia l reduction in the li keli hood of f uture events a nd improved mor ta lity, even a mong those in need of a hea r t or lung tra nspla nt. W hereas previous studies found a n improvement of approximately 30%, the M ACE study found a reduction twice as high. The implications a re clea r. "In our v iew, such patients — if they meet surg ica l cri- teria — shou ld be considered for ba riatric surger y," says Mehran Anvari, MD, PhD, Professor of Surger y at McMaster Universit y in Ha milton, Onta rio. According to Dr. A nva ri, the M ACE study establishes the need to have a la rge, multicenter, ra ndomized, controlled study to f ur ther look at the ef f icacy of ba riatric surger y in this population. To that end, he a nd his collea g ues a re working to secure f unding a nd hope to beg in their study soon. Physicia ns interested in pa r ticipating should contact Dr. A nva ri at a nva ri@mcmaster.ca . CUTTING SUBSEQUENT MI RISK IN HALF A n obser vationa l st udy i n Sweden fou nd t hat met abolic surger y plays a role in seconda r y prevention of myoca rdia l i n fa rction . In t he st udy, resea rchers demonst rated t hat metabolic surger y ha s no sig nif ica nt impact on stroke or newly developed atria l f ibrillation. It does, however, reduce t he r isk of deat h sig n i f ica nt ly a nd decrea ses new M I i n patients w it h severe obesit y a nd a persona l histor y of MI. " I a nticipated t hat t he surger y wou ld have a n ef fect , but not to t he ma g nit ude t hat we found," says Er i k Nä slund, M D, Ph D, P rofessor of Su rger y, Depa r t ment of Cl i n ica l Sciences, Da nder yd Hospit a l , K a rol i n sk a I n s t it ut et i n Stock holm, Sweden . Moving forward, Dr. Näslund laid out three steps to further va lidate the study 's f indings. 1. Perform research to determine if there is a difference in surgica l risk in patients with severe obesity and previous MI. 2. Determine if a ll patients with severe obesit y a nd pre- vious MI benef it from weight-loss surger y or whether some patients a re poor surg ica l ca ndidates. 3. Perform a ra ndomized clinica l tria l. Additiona l ly, Dr. Nä slund suspects t hose w it h T y pe 2 diabetes a nd prior MI may have the g reatest benef it from bariatric surgery, as it addresses both issues. Future research will be necessa r y to va lidate this theor y. PROVIDING A BRIDGE TO TRANSPLANT A novel path is being paved in bariatrics that is improving the lives of those awaiting a heart or lung transplant. Certain hospitals now use bariatric surgery in tandem with the implan- tation of a left ventricular assist device (LVA D) as a bridge to transplantation. Early results documented on the Thomas Jefferson University website indicate positive outcomes. "Despite being at higher risk for heart disease, when patients with obesity develop heart failure, their road to transplant can be frustrating," says Va khtang Tchantcha leishvili, MD, cardiac surgeon and Assistant Professor of Surgery at Thomas Jefferson University. "Our study shows that weight reduction surger y can help patients both lose weight and qua lif y for heart transplant, for which they were previously not eligible due to excessive weight." The patients were divided into two groups. One under- went both procedures at once, and the other underwent the procedures an average of two years apart. Both groups had positive results. ■ M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 0 2 2 0 9