Left ventricular reduction surgery with mitral valve repair

The echocardiographic changes and functional outcome from mitral valve repa ir, combined with partial left ventriculectomy (PLV), the Batista procedure , were investigated. From May 1996 to August 1997 the operation was perform ed on 57 patients, primarily (95%) transplant candidates with idiopathic di lated cardiomyopathy, All had been Class IV (36.8% had improved to Class II I by the time of surgery) on medical therapy, including 40% hospitalized on inotropes and 3 patients on intra-aortic balloon pumps. The mean cardiac i ndex was 2.1 +/- 0.6 L/min/m(2), with a wedge pressure of 24 +/- 8 mm Hg, a nd norepinephrine levels of 855 +/- 500 pg/mL (normal 80-526 pg/mL). There were 2 in-hospital mortalities (3.5%), At 3 months there were significant p ersistent changes in LV end-diastolic diameter (8.1 +/- 1.0 cm-6.3 +/- 0.9 cm) and ejection fraction (13.6 +/- 6%-23 +/- 7.7%). Subjective improvement included a mean change in NYHA functional class from 3.7 to 2.2, and objec tive changes included improvement in peak oxygen consumption from 10.6 +/- 4 mL/kg/min to 15.4 +/- 4.5 mL/kg/min. Actuarial survival at 1 year was 82. 1%; and freedom from death, relisting for transplantation, and need for LVA D support was 58%. The earliest "learning curve" experience with this relat ively unstudied operation warrants careful investigation. Many questions re main to be answered, but many patients have demonstrated early subjective a nd objective improvement.