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Ann Thorac Surg 2000;69:773
© 2000 The Society of Thoracic Surgeons

Commentary

Norman B. Ratliff, MDa

a Department of Pathology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA

Invited commentary

Partial left ventriculectomy, also known as the Batista procedure, has intrigued the medical world because it burst upon the scene amidst a glare of publicity in the lay press. The procedure was, from the beginning, counterintuitive. To suggest that excising viable myocardium would improve congestive heart failure seemed to fly in the face of all that had been learned about the importance of salvaging ischemic myocardium and limiting the size of myocardial infarcts. Nevertheless, early results were promising. As experience was gained, however, it became clear that subsets of patients did not improve, or worsened, and the procedure itself was not free of risk. Disturbingly, attempts to identify those subsets were not successful. Now, Cury and coworkers have identified a complication of the Batista procedure that may be a major determinant of a bad outcome.

In nine of 11 failed Batista procedures, Cury and associates found myocardial infarcts that involved one or both papillary muscles. The infarcts were adjacent to the excisions in the left ventricles. We have seen similar myocardial infarcts, so it is unlikely that the results of Cury and associates are unique to one institution. It is not difficult to understand how a myocardial infarct could undo whatever good might have been achieved by improving the ventricular geometry. Further, it is well known that the function of the mitral valve is compromised in dilated ventricles, so infarction of the papillary muscles might well be extremely deleterious in this setting.

Perhaps current attempts to achieve the positive effects of the Batista procedure (improved ventricular geometry) without excising muscle will avoid the complication of myocardial infarction.


Related Article

Autopsy findings in early and late postoperative death after partial left ventriculectomy
Patricia M. Cury, Maria de Lourdes Higuchi, Paulo S. Gutierrez, Luiz Felipe P. Moreira, Edimar A. Bocchi, Noedir A.G. Stolf, and Adib D. Jatene
Ann. Thorac. Surg. 2000 69: 769-773. [Abstract] [Full Text] [PDF]




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