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The Journal of Cardiovascular Surgery 2001 Aprile;42(2):175-85

lingua: Inglese

The Batista procedure. Theoretical analysis and clinical implications

Bridges C. R., Bogen D. *

From the Department of Surgery
*Depart­ment of Bio­en­gi­neering Uni­ver­sity of Penn­syl­vania, Philadelphia, USA


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Back­ground. The ­Batista pro­ce­dure ­leads to dra­matic ­early improve­ment in ­left ven­tric­ular func­tion in ­some ­patients and a wors­ening in func­tion in ­others. The theo­ret­ical and ­actual clin­ical ­effects of the pro­ce­dure on ­early post­op­er­a­tive ­left ven­tric­ular func­tion ­remain con­tro­ver­sial. The pur­pose of ­this ­study is to uti­lize an appro­priate math­e­mat­ical ­model to deter­mine the ­effects of the ­Batista pro­ce­dure on ­stroke ­volume and myo­car­dial ­wall ­stress. Our hypoth­esis is ­that the pre­op­er­a­tive end-sys­tolic ­stress (σes) is an impor­tant pre­dictor of ­early post­op­er­a­tive myo­car­dial func­tion ­after ­this pro­ce­dure. A cor­ol­lary is ­that an ­index ­related to σes may be ­useful in ­selecting ­patients for ­this pro­ce­dure.
­Methods. An anal­ysis of the ­Batista pro­ce­dure is devel­oped, ­based ­upon a spher­ical mem­brane ­model of the ven­tricle. ­This ­model ­shows how ven­tric­ular dil­a­ta­tion dis­torts the sys­tolic and dia­stolic pres­sure-­volume rela­tions.
­Results. Dil­a­ta­tion ­initially ­improves ven­tric­ular per­for­mance; but fur­ther dil­a­ta­tion, ­beyond a crit­ical ­value, pro­duces an ­unstable ­state ­with ­sharply ­falling per­for­mance. For a ven­tricle oper­ating sig­nif­i­cantly ­beyond the ­point of crit­ical dil­a­ta­tion, our theo­ret­ical ­results sug­gest ­that the ­Batista pro­ce­dure not ­only ­reduces myo­car­dial ­stress but may ­improve ­stroke ­volume. The end-sys­tolic ­stress, σes is an indi­cator of how ­close a ven­tricle is to the crit­ical dil­a­ta­tion ­point.
Con­clu­sions. ­There is a theo­ret­ical ­basis for the ­Batista pro­ce­dure. Resec­tion of myo­car­dium not ­only ­decreases ­wall ­stress but may ­improve ­stroke ­volume for suf­fi­ciently ­dilated and ­depressed ven­tri­cles. ­Patients ­with mark­edly ele­vated end-sys­tolic ­stress may ben­efit ­most ­from the ­Batista pro­ce­dure.

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