Batista procedure

The Batista procedure (also called a reduction left ventriculoplasty) was an experimental heart procedure that proposed the reversal of the effects of remodeling in cases of end-stage dilated cardiomyopathy refractory to conventional medical therapy. The hypothesis of the operation appears to be that reduction (resection) of marginally viable ventricular mass may result in superior geometric remodeling thus conferring better performance when faced with ventricular failure. In spite of promising initial results, the method was soon found to be of little if any benefit, and it is no longer considered a recommended treatment for the disease.

The Batista procedure was invented by Brazilian physician and cardiac surgeon Randas Batista in 1994 for use in patients with non-ischemic dilated cardiomyopathy. Many of his patients were victims of Chagas' Disease. Chagas' disease represents a parasitic nonischemic cardiomyopathy targeting parasympathetic inflow to the heart. Chagas' Cardiomyopathy thus represents a unique method of study of diastolic heart failure. It may be addressed by removal of a portion of viable tissue from the left ventricle to reduce its size (partial left ventriculectomy), with or without repair or replacement of the mitral valve.[1]

Although several studies showed benefits from this surgery, studies at the Cleveland Clinic concluded that this procedure was associated with a high early and late failure rate. At 3 years only 26 percent were event-free and survival rate was only 60 percent.[2] Most hospitals in the US have abandoned this operation and it is no longer included in heart failure guidelines.[3]

According to this article, likely to be written in 2002,[4] there is a modified Batista surgery done in Japan that has reported higher survival rate. An excerpt is show below.

"Hisayoshi Suma and his colleagues at the Hayama Heart Center have performed left ventriculoplasty in 238 patients over the last 5 years, including 138 patients with left ventricular (LV) dysfunction caused by coronary artery disease (CAD) and 100 patients with non-ischemic cardiomyopathy, mostly idiopathic dilated cardiomyopathy...

...expanding on patient selection, when the Batista operation was applied without any selection criteria, the in-hospital mortality rate was 43%, but this decreased to 15% with the use of site selection and intraoperative echo evaluation, which helps guide the choice of procedure. In the most recent 47 patients undergoing elective surgery, the hospital mortality was only 6.4%. "

References

  1. ↑ "Pioneers of heart surgery". NOVA Online: Cut to the heart. Archived from the original on 17 November 2007. Retrieved 2007-11-07.
  2. ↑ Franco-Cereceda A, McCarthy PM, Blackstone EH, et al. (May 2001). "Partial left ventriculectomy for dilated cardiomyopathy: is this an alternative to transplantation?". J. Thorac. Cardiovasc. Surg. 121 (5): 879–93. doi:10.1067/mtc.2001.113598. PMID 11326231.
  3. ↑ Tønnessen T, Knudsen CW (August 2005). "Surgical left ventricular remodeling in heart failure". Eur. J. Heart Fail. 7 (5): 704–9. doi:10.1016/j.ejheart.2005.07.005. PMID 16087128.
  4. ↑ "New Strategies in the Surgical Management of Advanced Heart Failure".


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