Role of Echocardiography in Bariatric Surgery: Preoperative Assessment of Non- Cardiopathic Morbidly Obese Patients

Abstract

Introduction: Morbidly obese patients are at risk of cardiovascular events and their optimal assessment before surgery is controversial. The aim of this study was to analyze the value of transthoracic echocardiography to detect structural and functional cardiac alterations and as a predictor of cardiovascular morbidity both in the operative period and in the immediate postoperative period in high risk but non-cardiopathic patients undergoing bariatric surgery. Material and Methods: A transthoracic echocardiography was routinely performed in non-cardiopathic patients with OSA and/or hypertension treated with two or more drugs. Eighty seven patients aged 48.5 ± 9 years, BMI of 45.9 ± 7 kg/m were studied. Cardiovascular risk factors, the anesthetic monitoring and the cardiovascular complications were evaluated. Results: An abnormal indexed left ventricular mass (LVMi) was observed in 12.6 % of patients, septum hypertrophy in 24%. Diastolic dysfunction (DD) was diagnosed in 32.7% of subjects (74% with a mild alteration). No significant differences were found in the echocardiography findings in patients with severe obesity (BMI > 50 kg/m2) compared with the rest of the subjects. In the linear regression analysis age (β=0.256, P=0.021) was found to be the main determinant of LVMi (R2 for the model= 0.314). Regarding intraoperative monitorization, two patients required special measures due to surgical complications and one patient suffered from a cardiovascular complication but in neither case did the echocardiografic findings prompt a change in the anesthesic management. Conclusions: The echocardiographic alterations found in a Mediterranean population of non-cardiopathic morbidly obese patients as candidates for bariatric surgery, were low. The echocardiographic findings did not change the anesthetic management of these patients and the cardiovascular events observed in the operative and immediate postoperative period were very scarce. This indicates that this test is not useful when routinely performed.