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Partial left ventriculectomy: Batista's operation in elderly patients

Background: Cardiac insufficiency is one of the most important problems challenging the public health resources in the modern world. The partial left ventriculectomy (Batista's Operation) is the most recent surgical treatment for the end-stage heart failure but, until now, without specific reports in the cardiovascular literature regarding its results in elderly patients. Objective: To study the results of the Batista's Operation in aged patients. Method: From May 1995 to December 1997, ten patients aged 62 to 78 years, suffering from dilated cardiomyopathy (class IV NYHA), were treated with the partial left ventriculectomy procedure in the Cardiothoracic Surgical Clinic of the Cardiothoracic Surgery Department of Mato Grosso do Sul Federal University -- (University Hospital Nucleus). Results: Nine (90%) patients were discharged from the hospital and one (10%) patient died in the 6th postoperative day from respiratory insufficiency. An elliptical resection was performed in the lateral wall of the left ventricle, from the apex to near the atrioventricular groove and between the papillary muscles. Dimensions of the removed fragment (mean values): 10.8+1.3 cm x 5.0+0.6 cm. The echocardiographic control has proved: <img SRC="http:/img/fbpe/rbccv/v16n1/5184q2.gif"> FE = fractional shortening, EF = ejection fraction, LVSD = left ventricular end-systolic diameter, LVDD = left ventricular end-diastolic diameter, DVL = diastolic volume lowering and SVR = systolic volume rised. In the late follow up three patients were in NYHA class I, three patients in class II and one in class III. The actuarial survival rate were 100%,87%,87% and 67% for 6, 12, 24 and 36 months respectively. Conclusion: The partial left ventriculectomy performed in elderly patients with cardiac insufficiency with severe hemodynamics disfunction resulted in 10% mortality, promoted important recovery of the cardiac performance by: improvement of NYHA functional class, enhancement of the ejection fraction and left ventricular % systolic shortening; reduction of the left ventricular systolic and diastolic diameters and determining better ventricular volume/mass ratio.

Cardiomyopathy, congestive; Heart ventricle; Cardiomyopathy; Cardiomyopathy; Myocardial insufficiency


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