The Shonan Kamakura experience - early results of the Batista operation

From December 1996 to December 1997, the Batista operation was performed in IS patients (12 men and three women with a mean age of 49 years) to treat cardiac failure due to nonischemic cardiomyopathy (mostly idiopathic dilate d cardiomyopathy). The preoperative NYHA class was IV in ii patients, inclu ding seven patients under inotropic support, and III in four patients. The cardiac procedures combined with partial left ventriculectomy (PLV) wer e: mitral valve reconstruction in 14 patients (13 replacements, one repair) , tricuspid annuloplasty in eight patients, aortic valve replacement in two patients, Maze procedure in one patient and CABG in one patient. All patients were successfully weaned from cardiolumonary bypass. An intra- aortic balloon pump was used in three patients and LVAD was not necessary T here were four in-hospital deaths but no late death. Ten (91%) of 11 patien ts who were operated on electively survived whereas only one (25%) of the f our patients who underwent urgent operations due to severe cardiac failure with pulmonary edema or cardiac arrest survived. Postoperative NYHA class w as I or II in nine patients and III in two patients. Left ventricular diast olic dimension and end-diastolic volume index were reduced from 77.2 +/- 6. 5 to 59.2 +/- 6.6 mm, and from 198.1 +/- 34.9 to 106.2 +/- 24.9 ml/m(2), re spectively, and ejection fraction increased from 17.9 +/- 6.9% to 31.1 +/- 4.6% - 4 weeks after the operation. No left ventricular redilatation was no ted during 6-12 months of follow-up. In conclusion, the Batista operation is a real hope for end-stage cardiomyo pathy. Operative mortality is acceptably low (9%) in the case of elective o peration whereas risk is very high in emergency cases due to ongoing shock. Proper guidelines regarding the suitability of the patient and the timing of the operation should be clearly defined to determine optimal use of the Batista operation.