Prospective evaluation of the Batista procedure with circulating atrial natriuretic peptides

A proposed treatment of end-stage heart disease is partial left ventricular resection (i.e., Batista procedure). To determine if congestive heart failure objectively improves after this procedure, we prospectively evaluated partial left ventriculectomy with objective plasma markers of the severity of congestive heart failure (i.e., three N-terminal atrial natriuretic peptide prohormone radioimmunoassays and atrial natriuretic peptide radioimmunoassay) prior to and during the 12 months after partial left ventriculectomy. The four measured atrial natriuretic peptides improved in 30% of the subjects at 1 month post-surgery. Eighty percent of the subjects, however, had higher circulating atrial natriuretic peptides (P<0.01) at 3, 6, and 12 months than prior to surgery indicating that their congestive heart failure was objectively worse than prior to surgery. Likewise, at 3, 6, and 12 months post-surgery the ejection fractions were not significantly better than prior to surgery. By 6 months the subjects with the highest circulating atrial natriuretic peptides had died (60% of subjects). In conclusion, congestive heart failure improves within 1 month in some patients but then deteriorates at 3, 6, and 12 months after the Batista procedure. There was no survival benefit with 60% of the patients expiring within 6 months after the Batista procedure.