Batista Procedure Research Articles

Early results with the batista procedure for end-stage heart failure

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: 83±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.

The Batista Operation for Heart Failure: Early Data.

The Batista operation is a recently developed procedure for patients with dilated left ventricles and severe heart failure, in which a large wedge of myocardium is resected in order to reduce the size of the left ventricle. Although …

Comparison of Maximal Left Ventricular Intramyocardial Artery Lumen Diameter in 2 Aneurysmectomy Specimen after TMR and 44 Control Patients

Summary TMR (Transmyocardial Laser Revascularization) is of value in angina pectoris not accessible to medication or conventional heart surgery. Therapeutical benefit is thought to be due to patent channels conveying blood from the lumen right into the wall of the left ventricle. Interestingly, histopathological findings of some autopsy patients fail to prove patent laser channels after TMR. We examine histopathological findings of left ventricular aneurysmectomy specimen 7 and 11 months after TMR. We compare the estimated (aneurysmectomy patients) or calculated (44 control patients) Equivalent Value for Left Ventricular Wall Tension (ET) to the Maximal Intramyocardial Artery Lumen Diameter (MIALD). The 44 control patients are selected out of different clinicopathological groups. The ET value is calculated using a simplifying spherical model of the left ventricle, and, like the MIALD value, is based on standardized histological samples of the anterior left ventricular wall and additionally the heart weight. We find an inverse non-linear regressive relationship between ET and MIALD values. This provides a morphologically based model for intramyocardial perfusion, which fits into theoretical physical models, putting the value of the reptile heart theory into question. Additionally it provides first morphological clues that reducing ventricular wall tension actually improves intramyocardial perfusion. We discuss, how the data not fitting into this model represents exceptions, how TMR might provide its beneficial effects, and how its value might be limited by the left ventricular wall tension, and on what basis the mechanism of other procedures such as ventriculectomy (also known as the Batista procedure) and coronary bypass surgery could be compared to our proposed mechanism of the TMR procedure.

Body surface mapping evaluation of repercussions of reductive ventriculectomy (batista operation) in the electrical activation of the heart

Body surface mapping evaluation of repercussions of reductive ventriculectomy (batista operation) in the electrical activation of the heart

Analysis of pre- and postoperative vectorcardiographic findings of patients subjected to reductive ventriculectomy (batista operation)

Analysis of pre- and postoperative vectorcardiographic findings of patients subjected to reductive ventriculectomy (batista operation)

Does Surgical Reduction of Heart Size Reduce Heart Failure

The recent introduction of surgical resection of a slice of the myocardium to treat severe dilated cardiomyopathy (the Batista operation) has gained widespread attention. In this report, investigators from the Bristol Heart Institute, U.K., recount their initial experiences with this operation in 14 patients. All but one patient were in New York Heart Association class IV owing to idiopathic cardiomyopathy (8), coronary heart disease (5), and valvular disease (1). …

Surgical Ventricular Remodeling: Pathophysiological Basis for the Cardioreduction (Batista) Procedure

The cardioreduction (Batista) procedure is a new surgical procedure being clinically performed for end-stage heart failure. It is the most recent of operations based on the concept of ventricular remodeling, among which dynamic cardiomyoplasty and temporary left ventricular assist device support are alternatives. Since the initial published report in 1996,cardioreduction has quickly been embraced by the public and many medical institutions throughout the world as an option to cardiac transplantation. There is very little scientific evidence regarding the beneficial effect and physiological principles behind cardioreduction. Since several clinical series are beginning to appear on the short-term results of cardioreduction, it is important to delineate the theoretical basis for the procedure. Cardioreduction is purported to be beneficial because it normalizes the cardiac ventricular mass-to-volume ratio. This review attempts to present the literature evidence of a universal ventricular mass-to-volume ratio and the physiological principle for cardioreduction.

Recent Innovations in Cardiac Surgery—A Symposium on Minimally Invasive Coronary Artery Bypass Surgery and Partial Left Ventriculectomy (Batista Operation) August 23–24, 1996 Buffalo, New York, USA

Recent Innovations in Cardiac Surgery—A Symposium on Minimally Invasive Coronary Artery Bypass Surgery and Partial Left Ventriculectomy (Batista Operation) August 23–24, 1996 Buffalo, New York, USA

Myocardial Fiber Diameter as a Good Indicator of Outcome in Batista's Operation

Abstract Background: Despite the initial promissory results of partial left ventriculectomy, or Batista's operation, the postoperative mortality associated with the procedure has been too high. We described a histopathologic study performed to identify histological parameters that could help to determine outcomes of patients undergoing this procedure. Methods and Results: Myocardial fiber diameter, myocardial fibrosis, thickness of the compact wall, and number of cells presenting from the endocardium to epicardium were analyzed in 32 patients with idiopathic dilated cardiomyopathy who underwent Batista's operation. Data were grouped by patients who died ≤ 6 months and patients who survived for &gt; 6 months after the surgical procedure. Additional analyses were performed to compare results according the causes of death and to test the application of these results to biopsy. Results: Myocardial fiber diameter was the only index that could distinguish the two groups. Myocardial fiber diameter &lt; 22 μm distinguished the group of patients who survived the 6‐month postoperative period from patients who died during that time with sensitivity of 85.7 and specificity of 72.2. The subendocardial region of the compact wall and the trabecular portion of the wall exhibited comparable results. Conclusion: Our results indicate that the myocardial fiber diameter of samples from the trabecular or subendocardial compact wall regions may help predict the outcome of left ventriculectomy. Samples from the trabecular or subendocardial compact wall regions were used for analysis. Further prospective studies involving left ventricular endomyocardial biopsies are necessary to confirm if the use of myocardial fiber diameter in the selection of patients for surgery improves the index of success of Batista's operation. Other factors that are involved remain unclear.

Partial Left Ventriculectomy (Batista Procedure) in the Treatment of Dilated Cardiomyopathy: Makati Medical Center Philippine Experience

Abstract In the Philippines patients with end‐stage heart disease refractory to conventional medical and surgical treatment do not have alternative choices. More than 99% of the population cannot afford cardiac transplantation. Partial left ventriculectomy (PLV) is a surgical procedure that improves cardiac function and refractory congestive heart failure (CHF). Between October 1997 and February 1998 eight patients had PLV at the Makati Medical Center, Philippines. All patients had end‐stage dilated cardiomyopathy. Six patients had an id‐iopathic etiology, one was ischemic and one valvular. Seven of eight operations were done with the heart beating and all had transesophageal echo monitoring. An average of a 2‐cm reduction in the left ventricle diameter was achieved and ejection fraction improved in all cases. There were no operative deaths. There were three late deaths. Two patients died of refractory CHF and ventricular arrhythmias and one patient died of massive cerebral hemorrhage with coumadin therapy. The five survivors are all doing well with no CHF. Follow‐up two‐dimensional echo shows stable left ventricular (LV) size and improved ejection fraction. Our initial experience shows that PLV, at least in the short‐term, has beneficial effects in the treatment of end‐stage dilated cardiomyopathy and might become an alternative to cardiac transplantation.

The Batista Operation in Patients with Dilated Cardiomyopathy

Abstract Between December 1996 and October 1998,34 patients with nonischemic dilated cardiomyopathy (DCM) received cardiac volume reduction surgery. The patients' ages ranged from 14 to 67 years (mean = 48 years) and included 28 males and 6 females. Associated mitral regurgitation was present in 31 patients, tricuspid regurgitation in 19 patients, and aortic regurgitation in 4 patients. We performed a partial left ventriculectomy (PLV) using antegrade intermittent warm blood cardioplegia in 15 patients (group A), and in 19 patients (group B) PLV was performed using the on‐pump beating heart technique. In group A, the mean aortic clamping time was 79 ± 33 minutes and the total cardiopulmonary bypass time was 155 ± 58 minutes. In group B the mean cardiopulmonary bypass time was 121 ± 43 minutes. There were eight hospital deaths (five in group A and three in group B). Five of 10 survivors of group A required inotropic support for 13.8 ± 25.3 days after the operation, while 5 of 12 survivors in group B required inotropes for 4.2 ± 3.1 days. Hospital mortality was 86% in 7 emergent cases and 7% in 27 elective cases. Echocar‐diographic study showed that the left ventricular ejection fraction improved from a mean of 18.7% to 30.3% and the left ventricular diameter decreased from a mean of 80.2 mm to 62.3 mm after the operation. All 26 hospital survivors were followed for 1 to 20 months. Three patients died at early follow‐up because of congestive heart failure, thrombosed valve, and hepatic failure, respectively. Nineteen patients were in New York Heart Association (NYHA) Class I or II and four were in NYHA Class III. In conclusion, cardiac volume reduction surgery is effective when the operative technique and proper judgment of patient selection are established, and emergent operation is avoided.