Effect Of Bariatric Surgery On Congestion Assessed By Remote Pulmonary Artery Pressure Monitoring In A Patient With Heart Failure With Preserved Ejection Fraction

Abstract

Background Bariatric surgery is associated with a decline in the rate of heart failure exacerbations and improved NYHA class, but little is known about its acute and incremental hemodynamic effects. We aimed to evaluate the change in hemodynamic profiles in a patient with HFpEF after bariatric surgery by measuring an implanted monitoring device. Methods A 57-year-old female with chronic HFpEF, NYHA Class III symptoms and morbid obesity (body mass index 50Kg/m2) had challenging HF management (multiple HF hospitalizations and urgent office visits) despite the use of a pre-implanted CardioMEMS™ device. Her diastolic pulmonary artery pressures ranged between 21-25 mmHg despite high loop (Torsemide 80mg daily) and thiazide (Metolazone 5 mg twice a week) diuretic doses. After etiologies were investigated, the patient was referred to a Weight Management Program and successfully underwent a laparoscopic sleeve gastrectomy. The Cardiomems readings post-operatively were daily monitored. Results The post-op course was uncomplicated. Day #1 post-op CardioMEMS reading showed 16 mmHg. Day #2 post-op reading showed 18 mmHg on no diuretics. Her pre-hospital regimen of torsemide 80mg daily and metolazone 5mg twice weekly was reduced to torsemide 20mg daily at discharge. Approximately 2 weeks later from discharge, her CardioMEMS device reading continued to show readings of 12 - 18 mmHg. Thereafter, the patient developed a mild acute kidney injury that was determined to be from hypovolemia. Her diuretic was completely stopped. Her CardioMEMS readings remained at or below goal for approximately five months during the observation of this case. The diastolic PA pressures was reduced on average by 4-6 mmHg after bariatric surgery on a significantly lower dose of diuretic. Interestingly, the drop in PA pressures occurred within the first week, even in the absence of a significant weight loss, and remained stable for about 5 months following the surgery. During the time period of this case, the patient had lost about 20 lbs since her bariatric surgery that represented 10% of her body weight. Conclusions The current case demonstrates significant improvement of hemodynamics after the bariatric surgery as monitored by the CardioMems™. Bariatric surgery should be considered a viable treatment option in the heart failure population. Future studies are needed to determine how the bariatric surgery mediates weight-loss independent improvements in cardiac diastolic function. Bariatric surgery is associated with a decline in the rate of heart failure exacerbations and improved NYHA class, but little is known about its acute and incremental hemodynamic effects. We aimed to evaluate the change in hemodynamic profiles in a patient with HFpEF after bariatric surgery by measuring an implanted monitoring device. A 57-year-old female with chronic HFpEF, NYHA Class III symptoms and morbid obesity (body mass index 50Kg/m2) had challenging HF management (multiple HF hospitalizations and urgent office visits) despite the use of a pre-implanted CardioMEMS™ device. Her diastolic pulmonary artery pressures ranged between 21-25 mmHg despite high loop (Torsemide 80mg daily) and thiazide (Metolazone 5 mg twice a week) diuretic doses. After etiologies were investigated, the patient was referred to a Weight Management Program and successfully underwent a laparoscopic sleeve gastrectomy. The Cardiomems readings post-operatively were daily monitored. The post-op course was uncomplicated. Day #1 post-op CardioMEMS reading showed 16 mmHg. Day #2 post-op reading showed 18 mmHg on no diuretics. Her pre-hospital regimen of torsemide 80mg daily and metolazone 5mg twice weekly was reduced to torsemide 20mg daily at discharge. Approximately 2 weeks later from discharge, her CardioMEMS device reading continued to show readings of 12 - 18 mmHg. Thereafter, the patient developed a mild acute kidney injury that was determined to be from hypovolemia. Her diuretic was completely stopped. Her CardioMEMS readings remained at or below goal for approximately five months during the observation of this case. The diastolic PA pressures was reduced on average by 4-6 mmHg after bariatric surgery on a significantly lower dose of diuretic. Interestingly, the drop in PA pressures occurred within the first week, even in the absence of a significant weight loss, and remained stable for about 5 months following the surgery. During the time period of this case, the patient had lost about 20 lbs since her bariatric surgery that represented 10% of her body weight. The current case demonstrates significant improvement of hemodynamics after the bariatric surgery as monitored by the CardioMems™. Bariatric surgery should be considered a viable treatment option in the heart failure population. Future studies are needed to determine how the bariatric surgery mediates weight-loss independent improvements in cardiac diastolic function.