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The Batista operation in patients with dilated cardiomyopathy
1Cardiovascular Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan. heartctr@fb3.so-net.or.jp
Insights
Cardiac volume reduction surgery effectively treats dilated cardiomyopathy (DCM) by improving ejection fraction and reducing ventricular diameter. Careful patient selection and avoiding emergent procedures are crucial for successful outcomes in DCM patients.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Heart Failure Management
Background:
- Nonischemic dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Surgical interventions aim to improve cardiac function and reduce symptoms in advanced DCM.
- Cardiac volume reduction surgery, specifically partial left ventriculectomy (PLV), has been explored as a treatment option.
Purpose of the Study:
- To evaluate the efficacy and safety of cardiac volume reduction surgery (PLV) in patients with nonischemic DCM.
- To compare outcomes between two surgical techniques: antegrade intermittent warm blood cardioplegia and on-pump beating heart.
- To identify factors influencing hospital mortality and long-term survival.
Main Methods:
- A cohort of 34 patients with nonischemic DCM underwent PLV between December 1996 and October 1998.
- Patients were divided into two groups: Group A (antegrade cardioplegia) and Group B (on-pump beating heart).
- Surgical times, hospital mortality, need for inotropic support, echocardiographic parameters, and long-term follow-up were analyzed.
Main Results:
- Hospital mortality was significantly higher in emergent cases (86%) compared to elective cases (7%).
- Left ventricular ejection fraction improved from 18.7% to 30.3%, and left ventricular diameter decreased from 80.2 mm to 62.3 mm post-surgery.
- The on-pump beating heart technique (Group B) showed a trend towards reduced inotropic support requirement compared to the cardioplegia group (Group A).
Conclusions:
- Cardiac volume reduction surgery can be effective for nonischemic DCM when appropriate operative techniques and patient selection criteria are applied.
- Avoiding emergent operations is critical for reducing hospital mortality.
- The study highlights the importance of careful patient management and surgical strategy in achieving favorable outcomes for DCM patients undergoing PLV.
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. Echocardiographic 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.