IJCS | Volume 32, Nº6, November / December 2019

653 Almeida Junior et al. Fourteen years’survival after batista operation Int J Cardiovasc Sci. 2019;32(6):650-654 Case Report PLV creation, several recent reports about its success rates have appeared, revealing a renewed interest on the subject. 5,7-10 Patients with advanced DCM under clinical therapy may have poor quality of life and unfavorable long- term prognosis, with or without ventricular volume reduction surgery, but it is also significant that many patients submitted to Batista procedure has lived for months or years, with much better clinical status and cardiac function than before. In our opinion, PLV can still be performed in selected patients with advanced heart failure, refractory to pharmacological therapy, when heart transplant is not available. It is important to note that patients submitted to PLV were compared in the literature with patients undergoing heart transplantation. There is no direct comparison of PLV with optimized clinical treatment, since the optimized clinical treatment failure is necessary for surgery indication. Only patients who remain very symptomatic with optimized clinical treatment or those who are inotropic-dependent have been indicated for treatment with PLV as an alternative to cardiac transplantation. In our patient, clinical treatment optimization was attempted to the maximum extent possible, but he remained refractory and dependent on inotropes, in what is now classified as INTERMACS 3. In our patient, the subsequent cardiac chamber redilation, the progression of mitral regurgitation over time and the decrease in ventricular function were all potential significant adverse factors for a favorable long- term outcome. However, it is extraordinary that, despite such limitations, he lived for 14 years, four months and 13 days after the operation. Possible explanations for the long-term survival would be the optimization of pharmacological therapy (he did not tolerate the use of beta-blockers and only reduced doses of ACEI were used before the surgery), as well as nutritional adjustment in the postoperative period (his weight at the time of surgery was 39 kg and after 1 year he reached 67 kg, compensated). In addition, the right ventriculectomy and the correction of the mitral-tricuspid regurgitation were factors that probably contributed to a favorable outcome. Conclusion This is a rare case of long-term survival of a patient with advanced heart failure, who was submitted to partial left ventriculectomy. Since the patient did not tolerate optimized clinical therapy, necessitating inotropic support, partial biventriculectomy and concomitant mitral and tricuspid repair were applied, resulting in a favorable outcome, allowing the patient to present excellent clinical recovery and an exceptional long-term survival. Acknowledgment To Cantídio Drumond Neto, in memoriam . Chief of Cardiology (6a Enf.) of Santa Casa da Misericórdia do Rio de Janeiro . Thank you for the support during the years when we cared for the patient described in the present report, for your friendship and for being a true master. His still strong presence continues to stimulate us to grow scientifically. Author contributions Conception and design of the research: Almeida Junior GLG, Jazbik W, Morgado JV, Almeida GLG. Acquisition of data: Almeida Junior GLG, Jazbik W, Morgado JV. Analysis and interpretation of the data: Almeida Junior GLG, Morgado JV, Almeida GLG. Writing of the manuscript: Almeida Junior GLG, Almeida GLG. Critical revision of the manuscript for intellectual content: Almeida Junior GLG, Morgado JV, Almeida GLG. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.