heart disease online : Heart Diseases resource HEART DISEASE ONLINE : Your resource for current and reliable information about HEART DISEASE.  It's so simple, even your child can understand !
Heart Disease information EVEN your child can understand !

LEARN
Heart Disease articles heart disease articles
Heart Disease resources
Heart Disease reports heart disease reports
READ
Heart Disease guides heart disease guides
Heart Disease books heart disease books
Heart Disease news heart disease news
TYPES
Congenital Heart Disease congenital heart disease
Coronary Heart Disease coronary heart disease
Rheumatic Heart Disease rheumatic heart disease
Ischemic Heart Disease ischemic heart disease
acute coronary syndrome acute coronary syndrome
RISKS
high cholesterol levels high cholesterol levels
smoking cessation quit smoking
aerobic exercise at home aerobic exercise at home
what is hypertension what is hypertension
ABOUT
Heart Disease Online heart disease online
heart disease facts heart disease facts
Signs of a Heart Attack signs of a heart attack
 

 


home / ARTICLES You Are Here Now Heart Valve Disease Coronary Artery Disease Congenital Heart Disease Congenital Heart Disease
HEART DISEASE ONLINE - Your resource on Heart Disease - all about the heart written in such a simple manner, EVEN your child can understand !
Heart Disease Articles
- By your Heart Disease Online guide photo of your guide to Heart Disease

Have a suggestion ?
Offer A Heart Disease Suggestion
Click here to
Tell the Doc


State of the Heart

Heart Fitness for Life : The Essential Guide to Preventing and Reversing Heart Disease

A Practical Guide
to YOUR Heart
and Heart Surgery

Click For More Info


Stay Informed

Join our mailing list.
Get the latest heart news by e-mail.



 

The Batista Operation

There has been so much media-hype about the innovative heart operation first performed by Dr.Randas Batista, that I thought an article on this procedure wouldn't be out of place on a site dealing with heart disease. So here goes.....

The Batista operation is a daring, innovative application of one of the basic physiologic tenets of cardiovascular medicine to the treatment of the difficult problem of end-stage heart failure. To understand the thinking and logic behind the operation, we first need to review cardiac physiology briefly.

Physiologic Basis of the Batista Operation.

The heart, as we have seen earlier, is a muscular pump that circulates blood within the blood vessels all over the body. The ventricles are the major pumping chambers, and the left ventricle is the more powerful one that maintains circulation to all organs except the lungs. When the left ventricle weakens and is unable to maintain its pumping action, a condition called heart failure sets in.

The heart action occurs in cycles. There is a phase of relaxation, during which the pressure inside the ventricle is lowered, and blood rushes into it from the atrium and fills it. This is followed by a phase of contraction, in which the blood collected inside the ventricle is pumped forcefully into the arterial tree.

By a series of physiologic experiments on animal heart muscle, two scientists - Frank and Starling - were able to show that the more the heart filled up during relaxation, the more forcefully it pumped blood during a subsequent contraction. This finding which is equally applicable to the human heart, is called the LAW OF THE HEART. They however qualified their statement by saying that this was true only WITHIN PHYSIOLOGIC LIMITS. In other words, upto a limit, filling up the heart increased force of contraction, but beyond this limit the force of contraction actually decreased.

Let us now consider the anatomic basis for this law. The heart wall is made up numerous small muscle cells, attached to each other and working together to pump blood out of the heart. Each muscle cell is bound by Starling's law. When the heart fills up, each individual muscle is stretched out. It then recoils with a greater force, somewhat like an elastic rubber band that snaps harder when it is stretched longer. But when the muscle cell is stretched beyond physiologic limits, it becomes damaged, and is no longer able to contract forcefully. This is true for all the muscle fibers, and as a result the entire ventricle becomes weak in its action. The heart fails !

The Batista Operation - What is it ?

The Batista Operation is technically called a REDUCTION LEFT VENTRICULOPLASTY. It is an open-heart operation performed with the aid of a heart lung machine to maintain circulation while the heart is stopped. The essence of the procedure is to remove a wedge of left ventricle muscle (weighing about 40 to as much as 250 grams) and stitch together the two edges of the ventricle. In this manner the size of the left ventricle is reduced, and the ventricle is remodelled as well.

In addition, sometimes, the mitral valve (which lies between the left ventricle and left atrium) may need to be removed and replaced with an artificial valve. In patients who have heart rhythm disturbances as well, an artificial implantable defibrillator device may be implanted. If the coronary arteries are diseased, they may be grafted too (CABG operation).

Theoretic basis of Batista Operation

In left ventricular failure, the muscle cells in the wall of the left ventricle have been stretched beyond physiologic limits, and Starling's law is no longer applicable. The Batista operation, by removing a wedge of the ventricular wall, reduces the circumference of the ventricle, and the size of the ventricle cavity. The individual muscle fibers are thus restored to their normal length, and now come within the physiologic limit. They thus function more effectively in pumping out blood. And in this way, heart failure is relieved !

In such a paradoxic manner, thus, removal of heart muscle tissue actually HELPS the heart pump more effectively. A radical concept indeed, the application of which Dr.Batista is to be commended for.

Who will benefit from the Batista Operation ?

The operation as described above is a radical departure from conventional thinking. Removal of too much muscle can weaken the heart and hasten death. It perhaps has the most potential benefit for patients with terminal heart failure caused by a disease of heart muscle (cardiomyopathy) and with a dilated left ventricle, who are not adequately palliated by medication and are awaiting a heart transplant.

Is the Batista Operation then the alternative to heart transplantation that it is much touted to be ?

Certainly not. While the media hype has projected the operation to be an alternative to heart transplantation, the results so far are NOT supportive of such a conclusion. Of Dr.Batista's original series, over 60% of patients were dead within two years of the operation. Dr.Batista himself is very conservative in his forecast for the role of the procedure. It certainly helps most patients for some time. In a potential heart transplant candidate, the Batista Operation buys some time, to allow a more suitable and better matched donor heart to be found. It thus may be a useful "bridge to transplantation".

Today, the only other alternative "bridge to transplant" is the use of a ventricular assist device (VAD). This is an extremely expensive option, and has a lot of complications and morbidity. The Batista operation may be an alternative to a VAD in such a setting. Ultimate heart transplantation however still remains an eventuality to be faced.

What is the role of the Batista Operation in the future ?

The answer is not yet known. Scientific analysis of data from patients who have undergone this procedure is still in a very premature stage. Without longer term follow up and extensive analyses of different factors, the ultimate place of the Batista procedure in the management of heart failure cannot be determined. But with the extensive use of this option for different stages and types of heart failure, such data will soon be available. Dr.Batista's unique innovation, flying in the face of conventional thinking, has set the world of cardiac surgery on fire, and forced a re-thinking of basic physiologic tenets. And perhaps this turmoil will turn up more exciting and useful information as well.

home / ARTICLES You Are Here Now Heart Valve Disease Coronary Artery Disease Congenital Heart Disease Congenital Heart Disease

 

 

 

LEGAL CONDITIONS AND TERMS OF USE APPLICABLE TO ALL USERS OF THIS SITE. ANY USE OF THIS SITE CONSTITUTES YOUR AGREEMENT TO THESE TERMS AND CONDITIONS OF USE.

Heart Disease Online does not provide medical advice, diagnosis or treatment. Material on this site is provided for informational purposes only. The site is not intended to supply personalized answers or advice to patients. It is not meant to be a substitute for professional medical advice. The information should not be used to diagnose or treat a health problem, disease, or to prescribe any medication. In case of doubt, promptly contact your health care provider. Never disregard professional medical advice or delay seeking it because of something you have read on Heart Disease Online. Click here for additional information and to read the full disclaimer and terms of use

Comments are welcome

Copyright © 1997-2013 Heart Disease Online , All rights reserved.
Terms of Use | Privacy policy | Disclaimer

Text, graphics, and HTML code are protected by US and International Copyright Laws,
and may not be copied, reprinted, published, translated, hosted, or otherwise
distributed by any means without explicit permission. Legal notices

Heart Disease Online (tm)
663, 99th Street, Madras, TN 60107
Fax : (603)-908 4676     E-mail : webmaster@heartdiseaseonline.com
URL : http://www.HeartDiseaseOnline.com