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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 2001 Aprile;42(2):175-85
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
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.