| Partial Left Ventriculectomy
(Batista procedure) and Its Perioperative Management |
(Department of Cardiovascular Surgery, Hiroshima
General Hospital, Hatsukaichi, Japan)
| Shogo Mukai |
Yasushi Kawaue |
Tatsuya Nakao |
|
This report describes the surgical
technique for partial left ventriculectomy (PLV) and perioperative
management. We have performed PLV to treat end-stage non-ischemic
cardiomyopathy in 6 patients (4 men and 2 women, mean age: 59
years) since February 1998. Preoperative New York Heart Association
(NYHA) functional class was III or more in all patients. On echocardiography,
the mean left ventricular diastolic dimension was 75mm, and the
mean ejection fraction was 29%. One patient was operated on with
cardiogenic shock, and 5 were elective cases. A wedge of the
left ventricular muscle was removed from the apex to the base
of the two papillary muscles. Associated surgical procedures
were as follows; mitral valve reconstruction in 5 patients (4
replacements and 1 annuloplasty), tricuspid annuloplasty in three,
and aortic valve replacement in one. Five elective patients were
successfully weaned from cardiopulmonary bypass, but one emergency
surgery case required intraaortic balloon pumping. Two patients
died in the hospital: one elective case was due to multiple organ
failure, and one emergency case due to low output syndrome. Three
of 4 survivors returned to NYHA functional class I-II, and 1
remained in class III. We are very cautious to ensure that extended
PLV does not to lead to serious diastolic dysfunction. The complete
reconstruction of the mitral valve and the preservation of annular-chordal-papillary
muscle continuity result in the maintenance of left ventricular
function and geometry. The practical principles in the post-PLV
period are to maintain adequate preload and to avoid excessive
afterload. Further studies are required to further enhance outcome.
Jpn. J. Cardiovasc. Surg. 30: 171-176 (2001) |
|
