Issue link: https://viewer.e-digitaledition.com/i/1500103
T h e r e s e a r c h e r s found that a mong obese indiv idua ls w ith a sig nif ica nt h i s t o r y o f m a j o r c a r d i a c e v e n t s , ba riatric surger y led to a substa ntia l reduction in the likelihood of f uture events a nd improved mor ta lit y, even a mon g t ho s e i n ne e d of a he a r t or lu n g t ra n spla nt . W herea s prev ious s t u d i e s fou n d a n i mpr o v e m e nt of approximately 30%, the M ACE study found a reduction t w ice a s high. The implications a re clea r. "In our view, such patients — if they meet su r g ica l cr it er i a — shou ld be considered for ba riatric surger y," says Mehra n A nva ri, MD, PhD, Professor of Surger y at McMaster University in Ha milton, Onta rio. According to Dr. A nva ri, the M ACE s t udy es t a bl i shes t he need t o h ave a l a r ge , mu lt ic ent er, r a n dom i z e d , cont rol led s t udy t o f u r t her look at t he ef f ica c y of ba r iat r ic su rger y i n this population. CUTTING SUBSEQUENT MI RISK IN HALF An observational study in Sweden found that metabolic surger y plays a role in seconda r y prevention of myoca rdia l infa rction. In the study, resea rchers demonstrated that metabolic surger y has no sig nif ica nt impact on stroke or newly developed atria l f ibrillation. It does, however, reduce the risk of death sig nif ica nt ly a nd decrea ses new MI in patients with severe obesit y a nd a persona l histor y of MI. "I anticipated that the surger y would have an effect, but not to the magnitude that we found," says Erik Näslund, MD, PhD, Professor of Surger y, Department o f C l i n i c a l S c i e n c e s , D a n d e r y d Hos pit a l , K a rol i n s k a I n s t it ut et i n Stockholm, Sweden. Dr. Nä slund la id out three steps to fur ther va lidate the study 's f indings. 1. Fur ther resea rch to determine if there is a dif ference in surg ica l risk i n patient s w it h severe obesit y a nd previous MI. 2 . Det er m i ne i f a l l pat ient s w it h s e v e r e o b e s i t y a n d p r e v i o u s M I benef it f rom weig ht-loss surger y or whether some patients a re poor sur- g ica l ca ndidates. 3 . Pe r f or m a r a n d om i z e d c l i n i- ca l tria l. Additiona lly, Dr. Nä slund suspects those with Ty pe 2 diabetes a nd prior MI may have the greatest benef it from ba riatric surger y, as it addresses both issues. Future resea rch will be neces- sa r y to va lidate this theor y. IMPROVING CHF WITH BARIATRICS Within the morbidly obese population, "the risk for hea r t fa i lure increa ses from 30% up to 100%," says Collin E.M. Brathwaite, MD, MS, FACS, Professor and Chair of the Department of Surgery, Chief of the Division of Minimally Invasive and Bariatric Surgery at NYU Long Island School of Medicine and Director of the Metabolic and Bariatric Surgery Program at NYU Langone Hospital–Long Island. B a s e d on r e s e a r c h t h a t s h o w e d positive effects of gastric by pass a nd sleeve gastrectomy on obese rats with diabetes and persona l experience with obese CHF patients, Dr. Brathwa ite a nd colleag ues launched resea rch to investigate whether bariatric surger y is a sa fe option for obese individua ls with CHF. "Currently, bariatric surgery is only being utilized in 1% of the population who may benefit from it," Dr. Brathwaite says. "The study suggests … bariatric surgery can be performed safely in patients with a history of CHF." Encouraging as this news is, the study wa s limited. It wa s retrospective in design (CHF patients who underwent ba riatric surger y over 11 yea rs were studied), a nd t here were not hemo- dynamic parameters associated with CHF diagnosis made for every patient. Despite this, Dr. Brathwaite insists that morbidly obese individuals with CHF can benefit from metabolic surgery. For optimal results, he specifies, they must be prepared for surgery with optimized conditions and provided surgical inter- vention by an experienced team using minimally invasive techniques. PROVIDING A BRIDGE TO TRANSPLANT A novel path is being paved in bariatrics t hat is i mprov i ng t he lives of t hose awa iting a hea r t or lung tra nspla nt. Cer ta in hospita ls now use ba riatric surgery in tandem with the implantation of a left ventricular assist device (LVAD) as a bridge to tra nspla ntation. Ea rly resu lts documented on t he Thoma s Jefferson University website indicate positive outcomes. "Despite being at higher risk for heart disea se, when patients w ith obesit y develop heart failure, their road to trans- plant can be frustrating," says Vakhtang Tchantchaleishvili, MD, cardiac surgeon and Assistant Professor of Surger y at Thomas Jefferson University. "Our study shows that weight reduction surger y can help patients both lose weight and qua lify for heart transplant, for which they were previously not eligible due to excessive weight." T h e p a t i e n t s w e r e d i v i d e d i n t o t w o g r o u p s . O n e u n d e r w e n t b o t h pr o c e du r e s a t on c e , a n d t h e o t h e r u nder went t he procedu res a n avera ge of t wo yea r s apa r t . B ot h g roups h a d posit ive resu lt s . n M D N E W S . C O M /// M D N E W S C E N T R A l P E N N S y lVA N i A n 2 0 2 3 1 5