Coronary Artery Bypass Surgery Performed after Laparoscopic Sleeve Gastrectomy in A Patient with Severe Obese of Severe Coronary Artery Stenosis

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

¹Department of Surgery, Iwate Medical University School of Medicine

²Department of Cardiovascular Surgery, Iwate Medical University School of Medicine

Cite this paper:
Yusuke Suto, Akira Sasaki, Akira Umemura, Yota Tanahashi, Hajime Kim and Hiroyuki Nitta. Coronary Artery Bypass Surgery Performed after Laparoscopic Sleeve Gastrectomy in A Patient with Severe Obese of Severe Coronary Artery Stenosis. American Journal of Medical Case Reports. 2026; 14(1):5-9. doi: 10.12691/ajmcr-14-1-2

Abstract

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.

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

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References:

[1]	Hubert HB, Feinleib M, McNamara PM, Castelli WP. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow up of participants in the Framingham Heart Study. Circulation 1983; 5: 968–77.
[2]	Umemura A, Sasaki A, Nitta H, Katagiri H, Kanno S, Takeda D, et al. A novel second-stage surgical strategy for severely obese patient with pancreatic neuroendocrine tumor: a case report. Surg Case Rep 2022; 8: 125.
[3]	Shioi Y, Sasaki A, Nitta H, Umemura A, Baba S, Iwaya T, et al. Two-stage surgery to repair a dissecting abdominal aortic aneurysm in a severely obese patient: open bifurcated graft replacement after laparoscopic sleeve gastrectomy. Asian J Endosc Surg 2016; 9: 149–51.
[4]	Tanahashi Y, Sasaki A, Umemura A. Reductions in epicardial adipose tissue and mediastinal far are associated with improved cardiac function. Obes Surg 2025; 35: 2854-2866.
[5]	Conte M, Petraglia L, Cabaro S, Valerio V, Poggio P, Pilato E, et al. Epicardial adipose tissue and cardiac arrhythmias: focus on atrial fibrillation. Front Cardiovasc Med 2022; 9: 932262.
[6]	Pereira JPS, Calafatti M, Martinino A, Ramnarain D, Stier C, Parmar C, et al. Epicardial adipose tissue changes after bariatric and metabolic surgery: a systematic review and meta-analysis. Obes Surg 2023; 11: 3636–48.
[7]	Takagi H, Umemoto T; ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Overweight, but not obesity, paradox on mortality following coronary artery bypass grafting. J Cardiol 2016; 3: 215–21.
[8]	Sasaki A, Yokote K, Naitoh T, Fujikura J, Hayashi K, Hirota Y, et al. Metabolic surgery in treatment of obese Japanese patients with type 2 diabetes: a joint consensus statement from the Japanese Society for Treatment of Obesity, the Japan Diabetes Society, and the Japan Society for the Study of Obesity. Diabetol Int 2021; 13: 1–30.
[9]	Umemura A, Sasaki A, Nikai H, Yanari S, Ishioka H, Takahashi N, et al. Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2022; 407: 2747–54.
[10]	Patel SV, Gill H, Shahi D, Rajabalan A, Patel P, Sonani R, et al. High risk for obstructive sleep apnea hypopnea syndrome predicts new onset atrial fibrillation after cardiac surgery: a retrospective analysis. Sleep Breath 2018; 22: 1117–24.
[11]	Yanari S, Sasaki A, Umemura A, Ishigaki Y, Nikai H, Nishijima T, et al. Therapeutic effect of laparoscopic sleeve gastrectomy on obstructive sleep apnea and relationship of type 2 diabetes in Japanese patients with severe obesity. J Diabetes Investig 2022; 13: 1073–85.
[12]	Herlitz J, Wognsen GB, Emanuelsson H, Haglid M, Karlson BW, Karlsson T, et al. Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery bypass grafting. Diabetes Care 1996; 19: 698–703.
[13]	Cooper WA, O'Brien SM, Thourani VH, Guyton RA, Bridges CR, Szczech LA, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation 2006; 113: 1063–70.
[14]	Maan S, Sohail AH, Sulaiman SA, et al. Metabolic and bariatric surgery versus glucagon-like peptide-1 receptor agonist therapy: A comparison of cardiovascular outcomes in patients with obesity. Am J Surg 2025; 242: 116242.
[15]	Wikiel KJ, McCloskey CA, Ramanathan RC. Bariatric surgery: a safe and effective conduit to cardiac transplantation. Surg Obes Relat Dis 2014; 10: 479–84.
[16]	Keleidari B, Mahmoudie M, Anaraki AG, Shahraki MS, Jamalouee SD, et al. Six month-follow up of laparoscopic sleeve gastrectomy. Adv Biomed Res 2016; 5: 49.