Two contrasting outcomes of weight loss surgery: Positive impact on the heart, negative impact on the liver

Abstract

Bariatric surgery results in significant weight loss in severely obese patients and is associated with beneficial as well as unintended negative consequences. Here we highlight the divergent impact of rapid weight loss in two individuals who underwent bariatric surgery. The first patient is a 58-year-old severely obese [body mass index (BMI) of 48.8 kg/m 2 ] Caucasian woman with metabolic syndrome and impaired left ventricular systolic function [preoperative left ventricular ejection fraction (LVEF) 29%]. After undergoing gastric banding, the LVEF improved to 65% at 24 months. This, along with a marked reversal of obesity-related comorbidities following surgery highlight the beneficial impacts that have popularized bariatric surgery. The second patient is a 27-year-old extremely obese (BMI = 81.0 kg/m 2 ) Hispanic man without metabolic syndrome and with normal preoperative cardiac and end organ function. One year after undergoing Roux-en-Y gastric bypass, his BMI had decreased to 28 kg/m 2 . The initial weight loss was rapid and paralleled by a loss of lean mass, muscle wasting and the development of cachexia with progressive liver failure and a diagnosis of crytopgenic hepatic cirrhosis. Herein we discuss the cases in detail and provide insight into the divergent impact of rapid weight loss on metabolic homeostasis, the heart, and end organ function. We hope this will aid with the preoperative risk/benefit assessment of severely obese patients being considered for weight loss surgery.