Yusuke Suto^1,, Akira Sasaki¹, Akira Umemura¹, Yota Tanahashi¹, Hajime Kim², Hiroyuki Nitta¹

Introduction: Obesity is a significant risk factor for cardiovascular disease and causes obesity-related disorders (ORD), which are risks for surgery. Metabolic and bariatric surgery (MBS) improve ORDs, reducing preoperative risk. We report the case of a patient with severe obese of severe coronary artery stenosis who underwent laparoscopic sleeve gastrectomy (LSG) prior to coronary artery bypass grafting (CABG) to reduce the risks associated with latter surgery. Case presentation: The 53-year-old (body mass index, BMI 43.2 kg/m²) male patient’s comorbidities included obstructive sleep apnea, hypertension, dyslipidemia, and osteoarthritis of the knee, all on treatment. Sufficient weight loss was not achieved, so LSG was planned. Preoperatively, three-vessel coronary artery disease indicated the need for CABG. Six months post-LSG, the excess and total weight losses were 36.8% and 19.1%, respectively. He continued to lose weight successfully and underwent CABG 8 months post-LSG. The postoperative course was favorable; he was discharged on postoperative day 13. Sixteen months post-CABG, there are no complications and his progress remains stable. Clinical discussion: Reports of two-stage cardiovascular surgery with preceding MBS are rare. However, MBS reduces visceral fat and improves several ORDs, thereby decreasing perioperative risks for CABG and potentially improving postoperative outcomes. While the “obesity paradox” occurs in cardiovascular surgery, the benefits of prior MBS outweigh this effect. Conclusion: MBS preceded CABG in this case, reduced the associated risks, and is likely to improve postoperative outcomes. Moving forward, the waiting period post-MBS, and the severity of the cardiovascular disease, require further investigation.

Case report, coronary artery disease, preoperative risk reduction, metabolic and bariatric surgery, second stage surgery, severe obesity