IJCS | Volume 32, Nº6, November / December 2019

DOI: 10.5935/2359-4802.20190024 650 CASE REPORT International Journal of Cardiovascular Sciences. 2019;32(6):650-654 Mailing Address: Gustavo Luiz Gouvêa de Almeida Junior Rua Macedo Sobrinho 445/307. Postal Code: 22271-080, Botafogo, Rio de Janeiro, RJ – Brazil. E-mail: gustavogouvea@cardiol.br, gustavogouvea@globo.com Fourteen Years’ Survival After Batista Operation: The Short History of a Long Journey Gustavo Luiz Gouvêa de Almeida Junior, 1 W aldir Jazbik, 3 Juliana Visconti Morgado, 4, 5 Gustavo Luiz Gouvêa de Almeida 2 Casa de Saúde São José, 1 Rio de Janeiro, RJ - Brazil Santa Casa da Misericordia do Rio de Janeiro, 2 Rio de Janeiro, RJ - Brazil Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro (UERJ), 3 Rio de Janeiro, RJ - Brazil Hospital Israelita Albert Sabin, 4 Rio de Janeiro, RJ - Brazil Hospital Casa Prontocor, 5 Rio de Janeiro, RJ - Brazil Manuscript received March 04, 2018; revised manuscript August 14, 2018; accepted September 03, 2018. Heart Failure/physiopathology; Partial Left ventriculectomy; Cardiac Surgery; VentricularDysfunction, Left/surgery; Cardiomyopathy, Dilated/surgery. Keywords Abstract A 41-year-old man with end-stage heart failure due to nonischemic dilated cardiomyopathy was submitted to the Batista procedure as an alternative to heart transplantation. With surgery, the patient showed progressive clinical amelioration, achieving long-term stable NYHA functional class II, despite gradual dilation of the heart chambers. Persistent atrial fibrillation appeared on the last year of life, his clinical condition deteriorated, and the patient died 14 years, four months, and 13 days after the operation. To the best of our knowledge this seems to be the longest reported survival for a patient submitted to Batista operation. Introduction Heart failure (HF) is one of most severe diseases affecting man, showing high morbidity and mortality. Once HF is diagnosed, survival is around 50% and 10% at 5 and 10 years, respectively. One of the main causes of heart failure is dilated cardiomyopathy (DCM), which is one of the main indications for heart transplant (HT). Historically, however, the potential benefits of HT have been very limited due to shortage of suitable donors, several contraindications, high financial costs and mortality due to infection, neoplasms, allograft rejection and other complications. 1-2 Meanwhile, a considerable proportion of patients die annually while on the waiting list and only a small proportion of candidates can benefit from a new heart. 1-2 To overcome such limitations, in the mid-1990s, the Brazilian surgeon Randas Batista and coworkers created an innovative and radical operation, named partial left ventriculectomy (also referred to as PLV, Batista operation and Batista procedure) to treat patients with end-stage heart failure as an alternative to HT. 3 By using an original concept based on Laplace’s law, where ventricular wall stress = intracavity pressure x radius/2 x wall thickness, the rationale for the procedure was that, by reducing the dilated ventricular cavity, a normalization of chamber volume/mass ratio could be re-established. Then, they postulated that a decrease in tension on the left ventricular wall through volume reduction could decreasewall stress and myocardial consumption of oxygen, resulting in systolic function improvement. The initial results obtained with the PLV generated tremendous enthusiasm among surgeons worldwide and more than 70 centers, at least 20 in Japan, performed the surgery in the 1990´s. At that time, several centers in Brazil adopted the surgery and the I Brazilian Guidelines for Cardiac Transplantation recognized PLV as an alternative to HT. 1 However, the prestige of PLV began to decline at 2001’s when a report from the Cleveland Clinic Foundation demonstrated perioperative failures that could preclude its widespread use. 4 At the same time, however, this study emphasized that, due to its possible beneficial effects, the Batista surgery could be employed in situations that do not allow a transplant or as a biological bridge to a newheart. Meanwhile in Japan, ventricular restoration surgery, includingmore a refined