Background

Outcomes of heart failure (HF) patients undergoing metabolic surgery (MS) are incompletely characterized. We aimed to describe cardiac and metabolic effects of MS in HF patients. We hypothesized patients with CHF would experience both improved metabolic and HF profiles.

Methods

A review of 2342 hospital records of patients undergoing MS (2017-2023) identified 63 patients with a medical history of HF. Preoperative characteristics, 30-day outcomes, and up to 2-year biometric & metabolic outcomes, medication usage, and emergency department utilization were examined. Wilcoxon signed-rank tests were used compare pre-op and post-op values, as well as generalized estimating equations (GEEs) to model longitudinal outcomes.

Results

Most patients (88.3%) had heart failure with preserved ejection fraction (HFpEF) versus 8.3% with reduced ejection fraction (HFrEF) (Table 1). MS consisted of sleeve gastrectomy (n=44), Roux-en-Y gastric bypass (n=17), and duodenal switch (n=2). At 24-months after MS, the mean BMI reduction was 14.8 (p<0.001) (Figure 1A); mean total body weight loss (%TBWL) was 29.2% (p<0.001) (Figure 1.a); and significant reductions in HbA1C were appreciated (p=0.02) (Figure 1B). Diuretic use was significantly lower at 24-months after MS (p=0.003) (Figure 1C). Emergency visits for cardiac-complaints (p=0.2) and IV-diuresis (p=0.07) trended lower at 1-year post-op (Figure 1D) but were not significant.

Conclusions

In carefully selected HF patients, metabolic surgery appears to provide significant reduction in oral diuretic dependency and metabolic improvements with trends toward lower rates of ED-utilization. Larger prospective studies investigating symptomatic improvement in patients with HFpEF and HFrEF are needed.