Issue link: https://viewer.e-digitaledition.com/i/1500459
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, " t he r isk for hea r t fa i lure increa ses from 30% up to 100%," says Collin E.M. Brathwa ite, MD, MS, FACS, Professor and Chair of the Department of Surgery, Ch ief of t he Div i sion of M i n i m a l ly Invasive and Bariatric Surger y at N Y U Long Isla nd School of Medicine a nd Director of the Metabolic and Bariatric Su r ger y P rog ra m at N Y U L a n gone Hospita l–Long Isla nd. Based on research that showed posi- tive effects of gastric bypass and sleeve gastrectomy on obese rats with diabetes and personal experience with obese CHF patients, Dr. Brathwaite and colleagues launched research to investigate whether bariatric surgery is a safe option for obese individuals with CHF. "Currently, ba riatric surger y is only being utilized in 1% of the population who may benefit from it," Dr. Brathwaite says. " The study suggests … ba riatric su rger y ca n be per for med sa fely i n patients with a histor y of CHF." Enc ou r a g i n g a s t h i s new s i s , t he st udy wa s limited. It wa s retrospec- t i v e i n d e s i g n (C H F p a t i e nt s w h o under went ba r iatr ic surger y over 11 yea rs were studied), a nd there were not hemody na mic pa ra meters a ssociated w it h CH F d ia g nosis ma de for ever y patient . Despite this, Dr. Brathwa ite insists that morbidly obese individua ls w ith CHF ca n benef it from metabolic s u r g e r y. Fo r o p t i m a l r e s u l t s , h e specif ies, t hey must be prepa red for su rger y w it h opt i m i zed cond it ion s a nd provided surg ica l inter vention by a n ex perienced tea m using minima lly inva sive 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." The patients were divided into two groups. One underwent both procedures at once, a nd the other under went the procedures a n avera ge of t wo yea rs apart. Both groups had positive results. ■ M D N E W S . C O M /// M D N E W S S O U T H C E N T R A L P E N N S y LVA N i A ■ 2 0 2 3 1 5