Partial Left Ventriculectomy to Improve Left Ventricular Function in End-Stage Heart Disease

Abstract

We present a case of a 34-year-old male with dilated cardiomyopathy in whom we performed a new surgical procedure; Le., ventricular volume reduction to improve function. This initial human experience was preceded by a series of ten sheep in which we demonstrated that by enlarging the left ventricle (LV), the ejection fraction was reduced, and by restoring normal diameter, the LV function returned to normal. (J Card Surg 7996;77:96-97)Over the last 45 years, we have observed that all animal hearts have the same muscle mass ratio (M = 4.18.R3. M = muscle mass; R = heart radius). Consequently, if any heart increases its diameter for any reason, the muscle mass has to increase to the cubic of each diameter increment in order to maintain normal left ventricular (LV) function. We performed experiments in sheep. By reducing the diameter of dilated LVs, their function improved. MATERIALS AND METHODSWe operated on a series of ten sheep, and obtained ejection fractions (EFs) preoperatively by cardiac catheterization and epicardial and transesophageal echocardiogram, where we could observe normal LV function (EF = 45%). On cardiopulmonary bypass (CPB), we divided the LV from the apex of the heart between the papillary muscles to the mitral valve annulus. A large pericardial patch was inserted to increase the ventricular diameter. None of the sheep came off bypass, and their EF fell down to 9%. Interestingly, the EF was low because the remaining normal heart muscle contractility was low when the diameter increased. CPB could be discontinued by removing the patch and returning the ventricle to previous normal measurements. The EF then returned to preoperative levels. CASE REPORTR.M., a 34-year-old male, was admitted August 1994 with heart failure New York Heart Association Class IV. There was peripheral edema and severe orthopnea. Cardiac catheterization ( Fig. 1) showed dilated cardiomyopathy with an EF of 17%.We proceeded with LV volume reduction by resecting a slice of LV between both papillary muscles, from the apex of the heart to the mitral annulus. The LV was repaired with a single 2-0 polypropylene suture. There were no problems weaning from bypass. RESULTSOne week postoperatively, we repeated the catheterization. The EF went up to 37% (Fig. 2). The patient had an uneventful postoperative course, and 2 months later, we repeated all of the laboratory data and the EF was 44%. Presently the patient is living a normal life.As of October 1995, we have performed the same operation on 154 patients.

Reconstrução fisiológica do ventrículo esquerdo: o conceito de máxima redução ventricular e mínima resposta inflamatória

“…Without doubt, part of the expressed concept in this surgical reconstruction technique of the left ventricle represents a direct application of the ideas developed in the weekly works of Brazilian authors, JATENE [1] and BATISTA et al [24].…”

Modified Batista Procedure for Idiopathic Dilated Cardiomyopathy: Report of a Case

“…However, there is a limited supply of hearts available for transplantation. As a surgical therapeutic option for the treatment of patients with end-stage DCM, PLV was first reported by Batista et al in 1996 [1].…”

“…In the original Batista procedure [1], the posterolateral wall of the left ventricle is widely resected. Some patients undergoing the procedure lose the coronary arteries, papillary muscles and mitral complex due to PVL.…”

“…Batista and colleagues [1] [2] reported partial left ventriculectomy (PLV) as a surgical option for the treatment of patients with severe dilated cardiomyopathies (DCM). Several studies [3] [4] [5] [6] [7] showed improvements in the left ventricular (LV) function and recovery from congestive heart failure in cases of DCM after the surgical procedure.…”

Surgical alternatives to transplantation for treatment of heart failure

“…This pioneering work has been undertaken by Dr R. Batista and has examined the aberration in left ventricular mass/volume relationship in patients with cardiomyopathy. Re-normalizing this relationship by reducing left ventricular chamber volume surgically (the Batista procedure) was proposed, aiming at reducing wall tension and improving myocardial contractility [3]. Early experience has shown that this procedure results in a significant improvement in left ventricular contractility and functional class in many patients [4,5].…”