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Surg Obes Relat Dis. 2012 Sep-Oct;8(5):634-40. doi: 10.1016/j.soard.2012.01.012. Epub 2012 Jan 28.

Evaluation and treatment of patients with cardiac disease undergoing bariatric surgery.

Author information

1
Division of General and Laparoscopic Surgery, Department of Surgery, University of Southern California, Los Angeles, California 90033, USA. nkatkhouda@surgery.usc.edu

Abstract

BACKGROUND:

Bariatric surgery is a proven tool in reducing the co-morbidities associated with morbid obesity. The aim of the present review was to assess the current data and discuss the strategies for preoperative evaluation, preoperative treatment, and intraoperative management of the obese patient with cardiac disease seeking bariatric surgery, including those who have undergone previous angiographic intervention with coronary stenting and/or antiplatelet therapy. The setting was a university hospital in the United States.

METHODS:

A search of the English-language reports using the keywords morbid obesity, bariatric surgery, perioperative risk assessment, coronary artery disease, coronary stents, and antiplatelet therapy was conducted.

RESULTS:

The methods of preoperative cardiac risk assessment found in the published studies included the use of certain criteria, stress echocardiography, and single-photon emission computed tomography. Preoperative medical treatment optimization with β-blockers and statins is recommended. Perioperative antiplatelet therapy in the form of aspirin 81 mg can be safely continued, but clopidogrel should be stopped and reinitiated with caution.

CONCLUSION:

Preoperative assessment of morbidly obese patients with coexisting cardiac issues presents unique challenges. Safe patient care and good clinical outcomes can be achieved with adherence to evidence-based practice.

PMID:
22398111
DOI:
10.1016/j.soard.2012.01.012
[Indexed for MEDLINE]

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