[Early results with partial left ventriculectomy (the Batista operation)]

The shortage of donors as well as the morbidity and mortality associated with transplantation have led to development of other surgical options for end-stage dilated cardiomyopathy. Partial left ventriculectomy reducing ventricular diameter and mass has been proposed. We here in report the initial experience (not only limited to the alternative of transplantation) and immediate results obtained with this technique in our institution.

Six patients with dilated cardiomyopathy underwent surgery: 4 of idiopathic origin with exclusion criteria for heart transplantation and 2 of valvular or mixed etiology. Resection of a slice of the left ventricle was performed between the two papillary muscles, from the apex of the heart to the mitral annulus, and closure was carried out with a single suture with mitral annuloplasty in 5 cases (tricuspid repair in one and aortic valve replacement in two).

An intraaortic balloon pump was required in two patients; one died from cardiogenic shock and the other died after several ventricular arrhythmias fifteen days after surgery. Intraoperative echocardiographic studies showed a significant reduction in both diastolic diameter (8.7 to 6.8 cm; p = 0.02) and mitral insufficiency and an increase in the ejection fraction (17 to 27%; p = 0.09) which were maintained on echography 10 days after surgery.

This technique is a feasible, suitable therapeutic option for refractory congestive heart failure. Appropriate patient selection, the perioperative management and long-term support remain to be defined.