Left ventricular volume reduction without ventriculectomy

Partial left ventriculectomy (the Batista procedure) to achieve left ventri cular volume reduction (LWR) has been advocated as an alternative to cardia c transplantation in patients with end-stage dilated left ventricles. Here, we describe a new technique of LWR that uses realignment of the papillary muscles, thus avoiding ventriculectomy, and report preliminary results. Eig ht patients tall male, mean age 49.3 [range 38 to 70] years) underwent LWR between October 1998 and March 2000 as an adjunct to surgical coronary reva scularization. Five were assessed with echocardiography and cardiopulmonary exercise testing before and after (mean follow-up time 267 [range 94 to 41 6] days) the operation. LWR significantly improved left ventricular end-dia stolic volume (254 +/- 32 to 218 +/- 36 mt, p = 0.03), left ventricular eje ction fraction (20.14% +/- 1.36% to 31.28% +/- 2.32%, p = 0.007), and exerc ise duration (from 394 +/- 88 to 611 +/- 79 seconds, p = 0.03). A nonsignif icant improvement in maximal oxygen consumption was also observed. This tec hnique of LWR is relatively simple to perform and is accomplished through a small apical cardiotomy. Preliminary results show an encouraging functiona l improvement following surgery. Future controlled studies are required to assess this novel technique further. (C) 2001 by The Society of Thoracic Su rgeons.