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Improvement in severe pulmonary hypertension in obese patients following laparoscopic gastric bypass or sleeve gastrectomy
*Eric G Sheu, *Denise W Gee
Massachusetts General Hospital, Boston, MA

Objective: To determine the safety and efficacy of bariatric surgery for the treatment of pulmonary hypertension.
Design: Retrospective, case-control study. Mean follow up = 25 months.
Setting: Tertiary academic hospital.
Patients: Morbidly obese patients followed in specialty pulmonary hypertension clinic who underwent bariatric surgery between 2009-2014 (n=10) and a BMI-matched control cohort managed with conservative therapy (n=10). Exclusion criteria were advanced malignancy and pulmonary hypertension secondary to thromboembolism.
Interventions: Laparoscopic gastric bypass or sleeve gastrectomy
Main outcome measures: Primary outcomes: pulmonary arterial pressures measured by echocardiogram and/or cardiac catheterization, use of pulmonary vasodilatory and diuretic medication, and need for home oxygen. Secondary outcomes: excess body weight loss, peri-operative morbidity and mortality, and inpatient length of stay.
Results: Patients who underwent bariatric surgery experienced significant 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) when compared to 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. Average length of stay post-operatively was 5 days.
Conclusions: Gastric bypass and sleeve gastrectomy markedly improves pulmonary hypertension in obese patients but has significant morbidity in this high risk patient population.


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