Cardiology News -
The Batista Procedure Disappoints
In the December, 2000 issue of the Journal of the American College of Cardiology (JACC), Dr. Randall Starling and colleagues from the Cleveland Clinic, in the largest and most carefully studied series yet reported, describe disappointing results using the Batista procedure in patients with severe heart failure.
The Batista procedure, popularized by Brazilian surgeon, Dr. Randas Batista, during the mid-1990s, involves removing a flap of heart muscle from the dilated left ventricles of patients with severe heart failure. The purpose of removing the muscle flap is to shrink the size of the ventricle and improve its geometry, thus improving the efficiency of cardiac function.
Dr. Batistas procedure stirred up much enthusiasm in the United States, mainly because it was so logical. The normal left ventricle is relatively small, muscular, and cylindrical in shape. When cardiomyopathy develops, the ventricle goes through a period of remodeling, in which it dilates (sometimes massively) and becomes spherical. This remodeling gives the heart certain short-term benefits, but in the longer term it significantly reduces the hearts ability to function normally. (For those of you who remember high school physics, this deterioration in cardiac function is a reflection of the Law of La Place, which states that the stress on the heart muscle will increase as the radius of the left ventricular chamber increases.) Therefore, reducing the size of the left ventricle (by excising a flap) ought to improve ventricular function.
Starling and colleagues performed the Batista procedure in 59 patients with severe heart failure and left ventricular dilation. They found that after the surgery, while approximately 25% improved, 33% of the patients rapidly deteriorated, and the remainder had only transient improvement in cardiac function, after which deterioration again set in. The Cleveland Clinic group, based on these results, have stopped performing the Batista procedure.
In an accompanying editorial in the December JACC, Dr. Mark Ratcliffe reviews all the information now known about the Batista procedure, and concludes (to paraphrase) that while ventricular reduction surgery probably improves the physics, the improvement is not sufficient to provide clinically significant benefits in cardiac function.
Both Ratcliffe and Starling credit Dr. Batista with drawing the attention of cardiac researchers to the potential benefits of reversing ventricular remodeling. They point to several other strategies being evaluated as ways of accomplishing this task in a more efficient and effective way.
Indeed, it is likely that at least some of the benefits now being seen with beta blockers and ACE inhibitors in patients with heart failure are related to the ability of these drugs to at least partially reverse ventricular remodeling. (See Beta Blockers are good for heart failure.)
In summary, cardiologists and their patients may owe a debt of gratitude to Dr. Batista for reminding us of physics 101, and the new avenues of investigation that flow there from, but we shouldnt get so carried away as to actually recommend, or receive, the Batista procedure.
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