Routine preoperative resting echocardiography does not predict adverse cardiopulmonary events after bariatric surgery

Background: A routine resting echocardiography has been suggested as a means to assess cardiac functioning and predict adverse cardiopulmonary events after bariatric surgery. Objectives: To describe the findings of routine resting echocardiographs in bariatric surgical candi-dates over a 3-year period and correlate them with observed adverse cardiopulmonary outcomes. Setting: Tertiary-care university-based referral hospital. Methods: We retrospectively reviewed 422 consecutive patients who underwent a laparoscopic sleeve gastrectomy or laparoscopic gastric bypass at our center over 3 years, of whom 321 (76%) received a routine resting preoperative echocardiogram. Abnormal preoperative echocardiogram findings and patient characteristics were recorded. The primary outcome measure was the number of adverse cardiopulmonary events within 30 days of surgery, a composite measure defined as any instance of myocardial infarction, sustained hypotension, stroke, new-onset arrhythmia, heart failure, intensive care admission for cardiopulmonary monitoring, or cardiac arrest. Results: Routine screening preoperative echocardiograms revealed left ventricular (LV) systolic dysfunction in 7 patients (2%), LV diastolic dysfunction in 71 patients (22%), LV hypertrophy in 73 patients (23%), wall motion abnormalities in 4 patients (1%), pulmonary hypertension in 47 pa-tients (15%), left atrial enlargement in 45 patients (14%), and LV enlargement in 6 patients (1%). Adverse cardiopulmonary events occurred in only 4 patients, all of whom had a history of coronary revascularization, and 3 of whom had a prior myocardial infarction. No finding on the routine preop-erative echocardiograms was associated with adverse cardiopulmonary events. Conclusion: A routine resting preoperative echocardiography added little to the cardiopulmonary risk stratification of patients who underwent bariatric surgery. High-risk patients were identifiable based on their medical history, particularly those with a known history of coronary artery disease and coronary revascularization. (Surg Obes Relat Dis 2021;17:1133-1139.) Published by Elsevier Inc. on behalf of American Society for Bariatric Surgery.

Automated summary

A routine resting preoperative echocardiography did not significantly improve the cardiopulmonary risk stratification of patients undergoing bariatric surgery. High-risk patients, particularly those with a history of coronary artery disease and coronary revascularization, can be identified based on their medical history.