[Batista partial left ventricular resection in terminal heart failure]

Congestive heart failure is a clinical condition with a high mortality. Medical therapy has improved the clinical course of these patients considerably in recent years. Numerous surgical interventions such as high risk coronary bypass surgery, resection of left ventricular aneurysms, heart valve replacement and cardiac transplantation became accepted therapeutical options. More recently, transmyocardial laser revascularization, implantation of mechanical assist devices, implantable cardioverters/defibrillators and dynamic cardiomyoplasty were introduced into clinical practice and are still under evaluation. For most patients suffering from congestive heart failure cardiac transplantation is the only therapeutical option. However, age of the patients, decreasing number of donors, mortality on the waiting list, high morbidity under immunosuppressive therapy and graft vasculopathy characterize the problems of this therapeutical strategy. The brasilian cardiac surgeon Randas Batista therefore has introduced a new organ preserving surgical technique. First reports on "partial left ventricular resection" for patients with end-stage cardiac failure and dilated ventricles are promising. The possible importance of this new surgical technique implies that precise clinical and scientific evaluation are imperatively needed. In this review we present the surgical procedure, published data on clinical outcome and hemodynamic changes and possible indications for this new technique. The few data which have been published so far might indicate that there is an acceptable perioperative mortality associated with a symptomatic improvement. However, intermediate and long-term follow-up data are not available, and refinements in the surgical technique are necessary.