Journal de l'obésité et du métabolisme

Abstrait

Morbid Obesity in End Stage Heart Failure: How Safe is Bariatric Surgery in Ventricular Assist Device Recipients?.

Aittigrine S, Tozzi P, Hullin R, Yerly P, Regamey J, Rösner L, Rusca M, Mantziari S, Suter M and Kirsch M

About 25% of patients enduring end stage cardiovascular breakdown (ESHF) are stout. BMI>40 keeps patients from getting an organ unite on the grounds that horrible corpulence (MO) drastically builds mortality after heart transplantation (HTx). Besides, MO (BMI>40) expands the danger of thromboembolic occasions by 20%. The treatment of ESHF in hefty patients must incorporate the treatment of their corpulence. Bariatric medical procedure (BS) is the best treatment for MO, yet has restrictive careful mortality in ESHF patients. One methodology is to initially embed a Left Ventricular Assist Device (LVAD) to give hemodynamic solidness during BS and in the long run decrease patient's BMI to values perfect with HTx (connect to-appointment approach). In any case, halting the anticoagulation for BS builds the danger of LVAD apoplexy or potentially thromboembolic occasions, especially in nearness of MO. We report the remedial pathway we applied to unravel this difficult circumstance. Technique: A 54 years of age man, previous smoker, with a BMI of 43.8 kg/m2 and rest apnea disorder, experienced ESHF because of ischemic (LAD impediment) and cadenced cardiomyopathy (non valvular atrial fibrillation) with CHA2DS2-VASC score 5. Left ventricle launch portion was 20%. Mean aspiratory pressure was 35 mm Hg and heart list was 2.0 l/min/m2