Is bariatric surgery safe for heart failure patients?

Question

Hi doctor,

My health has completely fallen apart because of my weight, and I am desperate for solutions. Currently 392 pounds at 5 feet 9 inches (BMI 57.9) with multiple severe complications. My diabetes was completely uncontrolled, with an HbA1c of 11.8 despite taking insulin (94 units daily), Metformin 2000 mg, and weekly Trulicity injections. Blood pressure consistently above 180/100 despite four different medications. Sleep apnea requires BiPAP at maximum settings with supplemental oxygen at night. Mobility is severely limited due to lymphedema in both legs and chronic venous insufficiency, causing constant leg wounds that would not heal despite weekly wound care. A recent echocardiogram showed an ejection fraction of 35 % with a diagnosis of obesity-related cardiomyopathy.

I have tried countless diets over the past 25 years and lost weight temporarily, then regained more every time. The latest attempt was a medically supervised program with a 1200-calorie diet for four months, which resulted in only a 12-pound loss despite perfect compliance, according to a dietitian. My endocrinologist finally referred me to the bariatric surgeon, but the cardiologist was concerned about surgical risks, given my heart condition. My biggest question: Am I even a candidate for surgery with such poor heart function? Which procedure would be safer - sleeve gastrectomy or bypass? Will diabetes and heart failure actually improve? How much weight might I realistically lose? And what is the recovery time? Currently on disability at age 45 due to mobility issues and chronic wounds. My quality of life is miserable, and I am desperate for any solution that might help.

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com

I have read your query and can understand your concern.

Thank you for letting us know about your health concerns. It is truly admirable that you are so proactive about your health.

As you rightly pointed out, obesity presents significant systemic health risks, including cardiovascular problems, endocrine disorders such as uncontrolled diabetes, and joint issues. Specifically, it affects your cardiovascular health by, among other things, placing undue strain on your heart and contributing to uncontrolled hypertension, atherosclerotic heart disease, obesity hypoventilation syndrome, pulmonary hypertension, and cor pulmonale.

Given the wide range of health concerns associated with obesity, addressing it is of paramount importance. Bariatric surgeries have become remarkably safe, and with the advent of advanced techniques, they are highly successful procedures.

Effective management of obesity leads to significant improvements in overall health. Weight loss can reduce insulin resistance, resulting in better blood sugar control. Similarly, blood pressure often improves, and blood lipid levels tend to fall within a healthier range. Furthermore, it lowers the risk of atherosclerotic heart disease progression and ischemia, consequently decreasing the likelihood of stroke, heart failure, and sudden cardiac death.

The risks associated with bariatric surgery vary depending on the specific type of surgery and the patient's overall health status. These risks can include infection, bleeding, leakages, perioperative cardiac events, arrhythmias, and potential long-term complications such as bowel obstruction, electrolyte imbalances, acidity and acid reflux, incisional hernias, and hypoglycemia. Considering your left ventricular systolic dysfunction, the risk is slightly elevated. However, the overall risk-versus-benefit profile generally favors undergoing bariatric surgery if your physician recommends it after a comprehensive evaluation of your overall health and fitness. I would recommend getting an evaluation done for your heart dysfunction, and if it is due to coronary artery disease, then address it first by revascularization and then going for bariatric surgery.

Which type of procedure will be better for you is a complex question and should be decided in collaboration with your bariatric surgeon, cardiac physician, gastroenterologist, and endocrinologist. All surgeries have promising results.

The degree of weight loss achieved can be substantial, although individual responses may vary. When bariatric surgery is combined with a tailored diet and medication, all under the supervision of an experienced healthcare professional, the outcomes are typically very positive.

Please do not hesitate to ask if you have any further questions. I would be pleased to address them.

I hope this information helps you.

Thank you.