Surgery & Cardiomyopathy

[Bob__0__0]

  I have a question about Cardiomyopathy and a procedure that was developed in Central America I believe.  It involves cutting out a piece of the heart to make the heart smaller and pump more efficiently.  I don't know the name unfortunately.
  Which Cardiomyopathy patients are appropriate for this procedure?  How is it done?  Are there any studies on its effectiveness so far?
  I have Cardiomyopathy- Congestive Heart Failure due to Adriamyacin therapy.  Has this procedure ever been done on someone like me? (my cancer is cured- 10 years out)  I'm 30 years old and active too.. I get tired but I manage ok..  My EF is 30 and under stress it goes up to 42... which is great I know.. at what point might I consider this procedure worthwhile? if at all?

[CCF CARDIO MD APS]

Dear Bob,
The procedure you speak of was developed by a Dr.Batista in Brazil and performed
mostly on patients with cardiomyopathy(CM) from an infection  called Chagas disease.
Most patients in the U.S. have cardiomyopathy from long standing heart disease
or simply one big heart attack(often termed ischemic cardiomyopathy).  A few american surgeons learned
of this procedure and we have been performing it here at the Cleveland Clinic for
a little over a year.  Currently we can only comment that a third of patients seem to improve after the Batista
procedure, a third do worse and a third remain unchanged.  The surgery has also been termed left ventricular reduction surgery and
with as many names there have also been some modicfications based on the knowledge of our excellent surgeons here.  This procedure is
very much discussed at all the major cardiology meetings and the surgeons are constantly monitoring information as well as sharing cases to better understand
who exactly will benefit most from this surgery.  At present the criteria are very strict for who can undergo this procedure, as well there as yet is no published data or general consensus on who should gest thid procedure, how effective it really is in the long run, etc.  For example, the Cleveland Clinic does a transplant evaluation first since no patient should really undergo this procedure without some backup or altenative should the patient not do well after the surgery.
As for you Bob, it sounds as if this is a surgery that you could be evaluated for but also that currently you are doing well and have alot of room to get worse before thinking about a transplant.  Because your CM is secondary to adriamycin there are other factors to consider, although in general we do not transplant or do unproven surgeries on patients who's heart failure is well controlled on medications taken by mouth.  If you would like an evaluation at the Cleveland Clinic just call
1-800-CCF-CARE and ask for an appointment with Dr.Starling or Dr.McCarthy who are the cardiologist and cardiothoracic surgeon respectively that head the program for reduction evaluation and surgery.  It would of course be best for you to discuss any such move with your regular physician who currently manages your heart disease.  Good Luck.  Information provided in the Heart Forum is intended for general informational purposes only.  Actual diagnosis and treatment can only be made by your physician(s).