The Batista procedure (partial left ventriculectomy) has emerged as an adjunct or possible replacement to cardiac transplantation as a surgical management for end-stage congestive heart failure. Clinical experience in various centres has shown widely divergent degrees of success. From May to November 1996, we performed partial left ventriculectomy in 32 patients, of whom 31 (97%) were heart transplant candidates. The range of ages was 34 to 72 years (mean, 54.6); 60% were NYHA Class IV and 40% Class III. Preoperatively 30 patients were thought to have idiopathic dilated cardiomyopathy; 1 case was familial, and 1 valvular. The lateral ventricular wall (circumflex territory) between the papillary muscles was the location for ventriculectomy in 31 patients. In 13 patients (40%) one or both papillary muscles were divided with additional left ventricular wall resection, and the papillary muscles were reimplanted. For 31 patients, the anterior and posterior mitral valve leaflets were approximated (Alfieri repair); 1 patient had mitral valve replacement. Echocardiography showed a significant decrease in left ventricular dimensions after resection: 8.3 ± 1.1 cm to 6.0 ± 0.7 cm (p < 0.001), and a reduction in mitral regurgitation with an increase in forward ejection fraction 15 ± 5.0% to 33 ± 10.7% in the operating room (p < 0.001). Six patients (16%) required a perioperative left ventricular assist device. At 3 months, actuarial survival was 93%. We conclude that the Batista procedure with mitral valve repair offers functional and clinical improvement to an unpredictable subgroup of patients. Predicting successful outcome on a case-by-case basis is now the main thrust of our ongoing investigation.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine