IJCS | Volume 32, Nº5, September/October 2019

533 1. Vest AR, Patel P, Schauer PR, Satava ME, Cavalcante JL, Brethauer S, et al. Clinical and echocardiographic outcomes after bariatric surgery in obese patients with left ventricular systolic dysfunction. Circ Heart Fail. 2016;9(3):e002260. 2. Persson CE, Björck L, Lagergren J, Lappas G, Giang KW, Rosengren A. Risk of heart failure in obese patients with and without bariatric surgery in Sweden-A Registry-Based Study. J Card Fail. 2017;23(7):530-7. 3. Albuquerque DC, Neto JD, Bacal F, Rohde LE, Bernardez-Pereira S, Berwanger O, et al; Investigadores Estudo BREATHE. I Brazilian Registry of heart failure - clinical aspects, care quality and hospitalization outcomes. Arq Bras Cardiol. 2015;104(6):433-42. Erratum in: Arq Bras Cardiol. 2015;105(2):208. 4. Shimada YJ, Tsugawa Y, Brown DF, Hasegawa K. Bariatric surgery and emergency department visits and hospitalizations for heart failure References Mourilhe-Rocha and Salvino Obesity and heart failure Int J Cardiovasc Sci. 2019;32(5):527-535 Review Article operative time, greater estimated blood loss, and longer length of hospital stay. By the end of the study period, two patients with LVAD had undergone heart transplantation, one of whom died due to antibody- mediated rejection three years after transplantation. Two patients were on the transplant list; one patient had a marked improvement in symptoms, being treated clinically; and the other patient was not eligible for transplant because of severe depression. 49 There are other reports on successful cases involving LVAD and bariatric surgery as bridge for heart transplantation 50,51 or improvement in ventricular function in morbidly obese patients. 52 Most references presented in this review showed good results for bariatric surgery in patients with HF. However, it is worth noting that most studies cited were on interventions primarily directed to treat obesity and not eventual cardiac dysfunction, either clinical or suggested by different assessment methods.  Conclusion Although some data suggest that obesity can provide a reduction in mortality of individuals with HF, weight loss, especially in the presence of morbid obesity, reduces symptoms and improves the quality of life of those patients. In addition, it provides reverse remodeling and increases LV ejection fraction in the presence of systolic dysfunction, in addition to enabling heart transplantation to eligible individuals. Bariatric surgery is an effective mean of weight loss. In patients with severe LV systolic dysfunction, however, although several studies have shown safety and efficacy, that procedure can be associatedwith severe complications and should only be performed in centers with trained specialists and advanced cardiac support involving multiple specialties. Most studies assessed have subdivided the analysis regarding neither etiology, nor the HFmodel, be it HFrEF or HFpEF. Future studies should assess the different models and etiologies in an individualized way and identify the most adequate surgical strategies. Thus, despite the risks, bariatric surgery should be considered for patients with HF, because of its potential to reduce the associated comorbidities and to improve quality of life and functional capacity, in addition to making eligible for heart transplantation those excluded due to high BMI. Author contributions Conception and design of the research: Mourilhe- Rocha R, Salvino NFA. Acquisition of data: Mourilhe- Rocha R, Salvino NFA. Analysis and interpretation of the data: Mourilhe-Rocha R, Salvino NFA. Writing of the manuscript: Mourilhe-Rocha R, Salvino NFA. Critical revision of themanuscript for intellectual content: Mourilhe-Rocha R, Salvino NFA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.