BUFFALO, N.Y.-A surgeon in Brazil is treating enlarged hearts by carving out a large piece of viable myocardium.
Dr. Randas Batista, who practices at Hospital Angelina Caron in Curitiba, violates cardiovascular dogma by excising viable left-ventricular muscle.
Yet he’s found that for many of 300 patients with dilated congestive cardiomyopathy, often resulting from Chagas’ disease, a smaller heart increases ejection fractions significantly. He takes an elliptical slice between the anterior and posterior papillary muscles.
Dr. Batista, whose paper on myocardial-volume reduction was rejected at a major thoracic meeting, has impressed skeptical U.S. surgeons who have gone to Brazil. Indeed, pilot studies have begun or are planned at the Cleveland Clinic, Brigham and Women’s, Yale-New Haven, and Buffalo General.
Dr. Tomas Salerno of Buffalo General is one of Dr. Batista’s champions. After going to Brazil to see with his own eyes what he felt made no sense, he now says the procedure could be a major development in heart surgery.
Dr. Salerno or colleagues have done ventricular remodeling here a dozen times for dilated cardiomyopathy from viral or valvular causes. He says the procedure’s role may also include ischemic disease. One patient in severe failure who'd been in the CCU for over three months had the equivalent volume of a normal heart removed, and he’s been discharged. Seven of the 12 patients are alive-one surviving 10½ months-and five have improved, says Dr. Salerno. Two more are unchanged.
At the Cleveland Clinic, Dr. Patrick McCarthy, who came back in May from Brazil, operated at once on two nonischemic cardiomyopathy patients. Both patients’ EFs rose from 10% to 40%, and they were discharged in nine days. He has since operated on two more, also nonischemic.
-Mark Bloom
BUFFALO, N.Y.-A surgeon in Brazil is treating enlarged hearts by carving out a large piece of viable myocardium.
