Batista procedure: elliptical modeling against spherical distention.

OBJECTIVE Batista's cardio-reduction of mass and diameter changes the geometry of the left ventricle (LV). This in vivo study explores the LV changing from spherical distention to elliptic modeling. METHODS Nineteen pigs were connected to cardio-pulmonary bypass (CPB), five of them without cardiac alteration (controls). The LV of the other fourteen pigs was incised between the left anterior descending and the circumflex arteries. Myocardial protection with the beating open method was used. In seven pigs, the LV incision was closed by direct suture to assess the surgical trauma of the Batista procedure (incision). In the other seven pigs a pericardial patch was placed for spherical distention of the LV as a model of heart failure (sphericalization). Patch removal and LV closure restored the normal cardiac geometry (elliptical modeling). Ventricular function was evaluated with Frank-Starling curves (stroke work index, SWI), with endsystolic elastance (EES) and diastolic compliance (beta(-1)) by impedance catheter, and with ejection fraction (EF) by transesophageal echocardiogram. Data were recorded after ventriculotomy, after sphericalization and after elliptical modeling (before and 30 min after discontinuation of CPB). RESULTS CPB did not significantly alter controls' hemodynamic. Ventriculotomy decreased cardiac function (as % vs. post CPB-controls: SWI* 63 +/- 4; EES 93 +/- 2; beta(-1)* 86 +/- 5). Sphericalization additionally impaired the function (as % vs. ventriculotomy: SWI* 57 +/- 4; EES* 60 +/- 7; beta(-1)* 45 +/- 8). The elliptical modeling greatly improved ventricular performance (as % vs. sphericalization: SWI** 156 +/- 5; EES** 162 +/- 8; beta(-1)** 177 +/- 7; EF** 216 +/- 5) (P < 0.05 for Student's unpaired* and paired** t-test). CONCLUSIONS Spherical distention of the left ventricular dimensions causes cardiac decompensation. The surgical trauma of the Batista procedure impairs the LV performance. However, the spherically distended LV benefits from Batista's cardio-reduction by elliptical modeling.