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Improvement in Severe Pulmonary Hypertension in Obese Patients following Laparoscopic Gastric Bypass
Eric G. Sheu1; Richard Channick2; Denise W. Gee2
1Brigham and Women’s Hospital, Boston, MA; 2Massachusetts General Hospital, Boston, MA

Background: Case reports have suggested bariatric surgery improves pulmonary hypertension. We performed a retrospective, case-control study to evaluate the safety and efficacy of bariatric surgery in patients with severe pulmonary hypertension.

Methods:Morbidly obese patients followed in a specialty pulmonary hypertension clinic who underwent laparoscopic gastric bypass or sleeve gastrectomy between 2009-2014 (n=10) were compared to a BMI-matched cohort managed with conservative therapy (n=10). Patients with advanced malignancy and pulmonary hypertension from thromboembolism were excluded. Primary outcomes assessed were changes in use of pulmonary vasodilatory and diuretic medications, need for home oxygen therapy, and mean pulmonary arterial pressures. Secondary outcomes measured were excess body weight loss, peri-operative mortality and morbidity, and hospital length of stay.

Results: More patients who underwent bariatric surgery experienced improvements in pulmonary arterial pressures (80% vs. 0%, p < 0.01), reduction or discontinuation of pulmonary vasodilatory therapy (67% vs. 0%, p < 0.01), and decreased diuretic requirements (86% vs. 0%, p < 0.01) than the control cohort. 75% of patients previously on home oxygen discontinued therapy after surgery, while oxygen requirements increased in 50% of the control cohort. Excess body weight loss was greater in the surgical group (EWL 68% vs. 19%, p < 0.001). Six significant complications in four patients occurred in the first post-operative year but there were no mortalities. Mean inpatient length of stay was 5 days.

Conclusions: Gastric bypass and sleeve gastrectomy markedly improves pulmonary hypertension in obese patients with an acceptable complication profile in this high risk population.

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