Introduction

There are an estimated 6 million Americans aged over 20

years living with heart failure (HF), and this number is

projected to increase to >8 million by 2030 [1]. Obesity is

one of the strongest risk factors for developing HF [2],

and according to a large study of Framingham Heart

Study participants, the risk of HF increases by 5% in men

and 7% in women for every 1 kg/m2 increase in body

mass index (BMI) [3].

Several studies have shown that bariatric surgery is safe

in patients with HF [7-10], and improves their eligibility

and access to transplantation [4-6]. In some cases,

bariatric surgery has been shown to eliminate the need

for cardiac transplantation altogether [5]. With the

increasing use of durable left ventricular assist devices

(LVADs) in the treatment of HF, evidence is emerging

regarding the successful use of bariatric surgery in

patients with LVADs [17-19]. The effects of nonsurgical

bariatric intervention (i.e., medical weight loss

management, dietary restrictions) compared with bariatric

surgery have not been well characterized in patients with

HF and LVADs.

Aim

To evaluate cardiac function and body mass index (BMI)

in patients with obesity and heart failure presenting for

bariatric management at our institution. Compare

outcomes between surgically treated and non-surgically

treated managed patients, assessing differences in left

ventricular ejection fraction (LVEF) and BMI. Additionally,

to examine outcomes in patients with LVADs.

Methods

We conducted a retrospective study reviewing the

electronic medical records of 25 patients with HF and a

BMI of 27 kg/m2 or more between 2019 and 2025.

Patients were stratified into surgically treated and non-

surgically treated managed cohorts. Patients were further

categorized from a cardiac standpoint based on whether

they had a durable LVAD or other advanced heart failure

therapy (AHFT). Changes in LVEF and BMI before and

after bariatric intervention were evaluated. Statistical

significance of differences in mean pre- and post-

intervention LVEF and BMI between cohorts was

assessed using paired t-tests.

Results

Twenty five patients were included in the study. The

cohort included 20 male patients (80%) and 5 female

(20%). Surgical procedures included 11 sleeve

gastrectomies and one Roux-en-Y gastric bypass. The

non-surgical group was composed of 13 patients. Within

the surgically treated group, only one patient (8.4%) had

a LVAD and eleven (91.6%) were being treated with

AHFT, meanwhile the nonsurgical cohort 9 (69.2%) had

an LVAD and 4 (21.8%) were on AHFT. Mean LVEF in

patients undergoing surgical bariatric procedures was

18.75% before intervention and 26.58% after surgery,

reflecting an 7.8% absolute increase. 58% of the patients

had an increase of their LVEF after bariatric surgery while

three (25%) had their LVEF worsened. In patients on

AHFT who were treated with surgical bariatric

intervention, mean LVEF increased from 19.77% pre-

surgery to 28.09% post-surgery, reflecting an 8.3%

absolute increase. In the nonsurgical cohort, LVEF was

reduced from 20.88% pre- intervention to 19.07% post-

intervention.

Conclusions

Bariatric surgery is safe among patients with HF

and obesity. While LVEF improvement was not

statistically significant, its increase after bariatric

surgery may still highlight a plausible treatment

option for improvement of left ventricular function

in patients with obesity and HF.

Bariatric surgery was a more effective means of

reducing BMI and improving LVEF than

nonsurgical bariatric intervention.