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Bariatric surgery among patients with heart failure: a systematic review and meta-analysis

BACKGROUND: Bariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effec...

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Autores principales: Berger, Sebastian, Meyre, Pascal, Blum, Steffen, Aeschbacher, Stefanie, Ruegg, Marco, Briel, Matthias, Conen, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307626/
https://www.ncbi.nlm.nih.gov/pubmed/30613414
http://dx.doi.org/10.1136/openhrt-2018-000910
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author Berger, Sebastian
Meyre, Pascal
Blum, Steffen
Aeschbacher, Stefanie
Ruegg, Marco
Briel, Matthias
Conen, David
author_facet Berger, Sebastian
Meyre, Pascal
Blum, Steffen
Aeschbacher, Stefanie
Ruegg, Marco
Briel, Matthias
Conen, David
author_sort Berger, Sebastian
collection PubMed
description BACKGROUND: Bariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF. METHODS: We performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery. RESULTS: We found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively. CONCLUSION: In this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF.
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spelling pubmed-63076262019-01-04 Bariatric surgery among patients with heart failure: a systematic review and meta-analysis Berger, Sebastian Meyre, Pascal Blum, Steffen Aeschbacher, Stefanie Ruegg, Marco Briel, Matthias Conen, David Open Heart Meta-Analysis BACKGROUND: Bariatric surgery reduces cardiovascular risk in obese patients. Heart failure (HF) is associated with an increased perioperative risk following bariatric surgery. This systematic review aimed to assemble the evidence on bariatric surgery in patients with known HF and the potential effect of bariatric surgery on incident HF in obese patients without prevalent HF. METHODS: We performed a comprehensive literature search up to 30 September 2017 and included studies comparing bariatric surgery to non-surgical treatment in patients with known presurgical HF. To assess whether bariatric surgery has any effect on incident HF, we also assembled studies looking at new-onset HF among patients without HF prior to surgery. RESULTS: We found five observational studies (0 randomised trials) comparing bariatric surgery with non-surgical treatment in patients with a diagnosis of HF prior to surgery. A review of the available studies (n=676 patients) suggested reduced admission rates for HF exacerbation and increased left ventricular ejection fraction after bariatric surgery. No meta-analysis was possible due to the heterogeneous nature of these studies. Seven studies (one randomised trial) reported data on new-onset HF in obese patients without HF prior to bariatric surgery (n=111 127 patients). When comparing surgical to non-surgical treatment groups, the pooled univariable and multivariable HRs for incident HF were 0.28 (95% CI 0.13 to 0.55) and 0.44 (95% CI 0.36 to 0.55), respectively. CONCLUSION: In this systematic review, no randomised trial assessed the benefits and risks of bariatric surgery in obese patients with concomitant HF. Available studies do, however, show that surgery might prevent incident HF. BMJ Publishing Group 2018-12-09 /pmc/articles/PMC6307626/ /pubmed/30613414 http://dx.doi.org/10.1136/openhrt-2018-000910 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0
spellingShingle Meta-Analysis
Berger, Sebastian
Meyre, Pascal
Blum, Steffen
Aeschbacher, Stefanie
Ruegg, Marco
Briel, Matthias
Conen, David
Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title_full Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title_fullStr Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title_full_unstemmed Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title_short Bariatric surgery among patients with heart failure: a systematic review and meta-analysis
title_sort bariatric surgery among patients with heart failure: a systematic review and meta-analysis
topic Meta-Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307626/
https://www.ncbi.nlm.nih.gov/pubmed/30613414
http://dx.doi.org/10.1136/openhrt-2018-000910
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