Cardiovascular evaluation and management of severely obese patients undergoing surgery: A science advisory from the american heart association

Circulation

Volumn 120, Issue 1, 2009, Pages 86-95

  Poirier, Paul ^a   Alpert, Martin A ^a   Fleisher, Lee A ^a   Thompson, Paul D ^a   Sugerman, Harvey J ^a   Burke, Lora E ^a   Marceau, Picard ^a   Franklin, Barry A ^a  

^a NONE

Author keywords

AHA Scientific Statements; Obesity; Surgery

Indexed keywords

ANTIBIOTIC AGENT; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; DESFLURANE; HEPARIN; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LOW MOLECULAR WEIGHT HEPARIN; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; PROPOFOL; SEVOFLURANE;

ANESTHESIA; ANESTHESIA INDUCTION; ANTIBIOTIC PROPHYLAXIS; ANTIBIOTIC THERAPY; ANTICOAGULANT THERAPY; ASSISTED VENTILATION; BACTERIAL ENDOCARDITIS; BARIATRIC SURGERY; BODY MASS; CARDIOMYOPATHY; CARDIOVASCULAR FUNCTION; CARDIOVASCULAR RISK; CLINICAL TRIAL; COMORBIDITY; CORONARY ARTERY ATHEROSCLEROSIS; DEEP VEIN THROMBOSIS; DIET; DYSPNEA; ELECTROCARDIOGRAM; EXERCISE TEST; HEART ARRHYTHMIA; HEART ATRIUM FIBRILLATION; HEART DISEASE; HEART FAILURE; HEART MUSCLE REVASCULARIZATION; HEART SURGERY; HOSPITALIZATION; HUMAN; HYPOVENTILATION; INTUBATION; KIDNEY FAILURE; LENGTH OF STAY; LUNG EMBOLISM; MEDICAL SOCIETY; OBESITY; PATIENT CONTROLLED ANALGESIA; PHYSICAL ACTIVITY; PHYSICAL EXAMINATION; POSTOPERATIVE CARE; POSTOPERATIVE PAIN; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; PULMONARY HYPERTENSION; REVIEW; SLEEP APNEA SYNDROME; SURGERY; TREATMENT INDICATION; UNITED STATES; WEIGHT REDUCTION;

AMERICAN HEART ASSOCIATION; CARDIAC SURGICAL PROCEDURES; COMORBIDITY; HEART DISEASES; HUMANS; OBESITY; PREVALENCE; RISK ASSESSMENT; RISK FACTORS; SEVERITY OF ILLNESS INDEX; UNITED STATES;

EID: 67651115502     PISSN: 00097322     EISSN: 15244539     Source Type: Journal    
DOI: 10.1161/CIRCULATIONAHA.109.192575     Document Type: Review

References (69)

1. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association scientific statement on obesity and heart disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898-918.
2. McInnis KJ, Franklin BA, Rippe JM. Counseling for physical activity in overweight and obese patients. Am Fam Physician. 2003;67:1249-1256.
3. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187-193.
4. Standards Committee, American Society for Bariatric Surgery. Guidelines for reporting results in bariatric surgery. Obes Surg. 1997;7: 521-522.
5. Sturm R. Increases in clinically severe obesity in the United States, 1986-2000. Arch Intern Med. 2003;163:2146-2148.
6. Nguyen NT, Wilson SE. Complications of antiobesity surgery. Nat Clin Pract Gastroenterol Hepatol. 2007;4:138-147.
7. Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract. 2008;14(suppl 1):1-83.
8. Kopelman PG. Obesity as a medical problem. Nature. 2000;404: 635-643.
9. Peeters A, Bonneux L, Nusselder WJ, De Laet C, Barendregt JJ. Adult obesity and the burden of disability throughout life. Obes Res. 2004;12: 1145-1151.
10. Murphy NF, MacIntyre K, Stewart S, Hart CL, Hole D, McMurray JJ. Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study). Eur Heart J. 2006;27:96-106.
11. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci. 2001;321:225-236.
12. Wong CY, O'Moore-Sullivan T, Leano R, Byrne N, Beller E, Marwick TH. Alterations of left ventricular myocardial characteristics associated with obesity. Circulation. 2004;110:3081-3087.
13. Poirier P, Martin J, Marceau P, Biron S, Marceau S. Impact of bariatric surgery on cardiac structure, function and clinical manifestations in morbid obesity. Expert Rev Cardiovasc Ther. 2004;2:193-201.
14. Alpert MA, Terry BE, Mulekar M, Cohen MV, Massey CV, Fan TM, Panayiotou H, Mukerji V. Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and effect of weight loss. Am J Cardiol. 1997;80: 736-740.
15. McTigue K, Larson JC, Valoski A, Burke G, Kotchen J, Lewis CE, Stefanick ML, Van Horn L, Kuller L. Mortality and cardiac and vascular outcomes in extremely obese women. JAMA. 2006;296:79-86.
16. Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141:1115-1120.
17. Livingston EH, Arterburn D, Schifftner TL, Henderson WG, DePalma RG. National Surgical Quality Improvement Program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203:625-633.
18. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142:621-632.
19. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22: 2554-2563.
20. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof E, Fleischmann KE, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Riegel B, Robb JF, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Antman EM, Buller CE, Creager MA, Ettinger SM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Ornato JP, Page RL, Tarkington LG, Yancy CW. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 2007;116:e418-e499.
21. published corrections appear in Circulation. 2008;118:e143-e144
22. Circulation. 2008;117: e154
23. Karason K, Lindroos AK, Stenlöf K, Sjöström L. Relief of cardiorespiratory symptoms and increased physical activity after surgically induced weight loss: results from the Swedish Obese Subjects Study. Arch Intern Med. 2000;160:1797-1802.
24. Nakajima T, Fujioka S, Tokunaga K, Matsuzawa Y, Tarui S. Correlation of intraabdominal fat accumulation and left ventricular performance in obesity. Am J Cardiol. 1989;64:369-373.
25. Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A. Influence of overweight on ICU mortality: a prospective study. Chest. 2004;125:1441-1445.
26. El Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120:1989-1997.
27. Bernstein AD, Parsonnet V. Bedside estimation of risk as an aid for decision-making in cardiac surgery. Ann Thorac Surg. 2000;69:823-828.
28. Wigfield CH, Lindsey JD, Muñoz A, Chopra PS, Edwards NM, Love RB. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI-or-40. Eur J Cardiothorac Surg. 2006;29: 434-440.
29. Villavicencio MA, Sundt TM III, Daly RC, Dearani JA, McGregor CG, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV. Cardiac surgery in patients with body mass index of 50 or greater. Ann Thorac Surg. 2007;83:1403-1411.
30. Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am. 1998;80:1770-1774.
31. McKee MD, Waddell JP. Intramedullary nailing of femoral fractures in morbidly obese patients. J Trauma. 1994;36:208-210.
32. Batsis JA, Huddleston JM, Melton LJ IV, Huddleston PM, Lopez-Jimenez F, Larson DR, Gullerud RE, McMahon MM. Body mass index and risk of adverse cardiac events in elderly patients with hip fracture: a population-based study. J Am Geriatr Soc. 2009;57:419-426.
33. McCullough PA, Gallagher MJ, DeJong AT, Sandberg KR, Trivax JE, Alexander D, Kasturi G, Jafri SM, Krause KR, Chengelis DL, Moy J, Franklin BA. Cardiorespiratory fitness and short-term complications after bariatric surgery. Chest. 2006;130:517-525.
34. DeMaria EJ, Portenier D, Wolfe L. Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass. Surg Obes Relat Dis. 2007;3:134-140.
35. DeMaria EJ, Murr M, Byrne TK, Blackstone R, Grant JP, Budak A, Wolfe L. Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity. Ann Surg. 2007;246:578-582.
36. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043-1049.
37. Garcia S, Moritz TE, Ward HB, Pierpont G, Goldman S, Larsen GC, Littooy F, Krupski W, Thottapurathu L, Reda DJ, McFalls EO. Usefulness of revascularization of patients with multivessel coronary artery disease before elective vascular surgery for abdominal aortic and peripheral occlusive disease. Am J Cardiol. 2008;102:809-813.
38. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, Xavier D, Chrolavicius S, Greenspan L, Pogue J, Pais P, Liu L, Xu S, Málaga G, Avezum A, Chan M, Montori VM, Jacka M, Choi P; POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839-1847.
39. Kaafarani HM, Atluri PV, Thornby J, Itani KM. Beta-blockade in noncardiac surgery: outcome at all levels of cardiac risk. Arch Surg. 2008; 143:940-944.
40. Minocci A, Guzzaloni G, Marzullo P, Savia G, Tagliaferri M, Berselli ME, Liuzzi A. Abdominal fat index by ultrasound does not estimate the metabolic risk factors of cardiovascular disease better than waist circumference in severe obesity. Diabetes Metab. 2005;31:471-477.
41. Drapeau V, Lemieux I, Richard D, Bergeron J, Tremblay A, Biron S, Marceau P, Mauriège P. Waist circumference is useless to assess the prevalence of metabolic abnormalities in severely obese women. Obes Surg. 2007;17:905-909.
42. Chui PT, Gin T, Oh TE. Anaesthesia for laparoscopic general surgery. Anaesth Intensive Care. 1993;21:163-171.
43. Drolet B, Simard C, Poirier P. Impact of weight-loss medications on the cardiovascular system: focus on current and future anti-obesity drugs. Am J Cardiovasc Drugs. 2007;7:273-288.
44. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116:1736-1754.
45. published correction appears in Circulation. 2007;166:e376-e377
46. George-Phillips KL, Bungard TJ. Use of low-molecular-weight heparin to bridge therapy in obese patients and in patients with renal dysfunction. Pharmacotherapy. 2006;26:1479-1490.
47. Gallagher MJ, Franklin BA, Ehrman JK, Keteyian SJ, Brawner CA, deJong AT, McCullough PA. Comparative impact of morbid obesity vs heart failure on cardiorespiratory fitness. Chest. 2005;127:2197-2203.
48. Bhat G, Daley K, Dugan M, Larson G. Preoperative evaluation for bariatric surgery using transesophageal dobutamine stress echocardiography. Obes Surg. 2004;14:948-951.
49. Schumann R, Jones SB, Ortiz VE, Connor K, Pulai I, Ozawa ET, Harvey AM, Carr DB. Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery. Obes Res. 2005; 13:254-266.
50. Perilli V, Sollazzi L, Modesti C, Annetta MG, Sacco T, Bocci MG, Tacchino RM, Proietti R. Comparison of positive end-expiratory pressure with reverse Trendelenburg position in morbidly obese patients undergoing bariatric surgery: effects on hemodynamics and pulmonary gas exchange. Obes Surg. 2003;13:605-609.
51. Coussa M, Proietti S, Schnyder P, Frascarolo P, Suter M, Spahn DR, Magnusson L. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98: 1491-1495.
52. Rao SL, Kunselman AR, Schuler HG, DesHarnais S. Laryngoscopy and tracheal intubation in the head-elevated position in obese patients: a randomized, controlled, equivalence trial. Anesth Analg. 2008;107: 1912-1918.
53. Gander S, Frascarolo P, Suter M, Spahn DR, Magnusson L. Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients. Anesth Analg. 2005;100:580-584.
54. Rose DK, Cohen MM. The airway: problems and predictions in 18,500 patients. Can J Anaesth. 1994;41(pt 1):372-383.
55. Brodsky JB, Lemmens HJ, Brock-Utne JG, Vierra M, Saidman LJ. Morbid obesity and tracheal intubation. Anesth Analg. 2002;94:732-736.
56. Mashour GA, Kheterpal S, Vanaharam V, Shanks A, Wang LY, Sandberg WS, Tremper KK. The extended Mallampati score and a diagnosis of diabetes mellitus are predictors of difficult laryngoscopy in the morbidly obese. Anesth Analg. 2008;107:1919-1923.
57. Juvin P, Vadam C, Malek L, Dupont H, Marmuse JP, Desmonts JM. Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg. 2000;91:714-719.
58. Strum EM, Szenohradszki J, Kaufman WA, Anthone GJ, Manz IL, Lumb PD. Emergence and recovery characteristics of desflurane versus sevoflurane in morbidly obese adult surgical patients: a prospective, randomized study. Anesth Analg. 2004;99:1848-1853.
59. De Baerdemaeker LE, Jacobs S, Den Blauwen NM, Pattyn P, Herregods LL, Mortier EP, Struys MM. Postoperative results after desflurane or sevoflurane combined with remifentanil in morbidly obese patients. Obes Surg. 2006;16:728-733.
60. Schumann R, Shikora S, Weiss JM, Wurm H, Strassels S, Carr DB. A comparison of multimodal perioperative analgesia to epidural pain management after gastric bypass surgery. Anesth Analg. 2003;96:469-474.
61. Whalen FX, Gajic O, Thompson GB, Kendrick ML, Que FL, Williams BA, Joyner MJ, Hubmayr RD, Warner DO, Sprung J. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg. 2006;102: 298-305.
62. published correction appears in Anesth Analg. 2006;102:881
63. Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14:1165-1170.
64. Klein S, Burke LE, Bray GA, Blair S, Allison DB, Pi-Sunyer X, Hong Y, Eckel RH. Clinical implications of obesity with specific focus on cardiovascular disease: a statement for professionals from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2004;110:2952-2967.
65. Poirier P, Després JP. Exercise in weight management of obesity. Cardiol Clin. 2001;19:459-470.
66. Mattsson E, Larsson UE, Rössner S. Is walking for exercise too exhausting for obese women? Int J Obes Relat Metab Disord. 1997;21: 380-386.
67. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, Hesson LA, Osei SY, Kaplan R, Stunkard AJ. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005;353:2111-2120.
68. Van Gaal LF, Rissanen AM, Scheen AJ, Ziegler O, Rössner S; RIOEurope Study Group. Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet. 2005;365: 1389-1397.
69. published correction appears in Lancet. 2005;366:370