Eduardo Benchimol Saad
Sixth year medical student - The Federal University of Rio de Janeiro
The Cleveland Clinic presented its experience with the innovative Left Ventricular Remodeling Surgery ( or Partial Ventriculectomy ), described by the brazilian surgeon Randas Batista.
There was no operative mortality, with 84 % of patients being discharged from hospital, of which 30 % was readmited for Heart Failure symptoms and 11 % relisted for transplantation. Three quarters of patients had significantly improved functional status. Five patients have required Left Ventricular Assist Devices and two have had a cardiac transplantation.
After 3 months of follow up, 75 % of patients were in NYHA class I or II and have been taked off from the transplant list, although there was no alterations in the hemodynamic measures. At 6 months, survival achieved 93 %, which is similar to tranplantation, classifying this procedure as a good alternative to transplantation, specially in developing countries and in places with no experience in managing imunossupressed patients.
Following the same line of evidence, in which remodeling the dilated ventricles have a beneficial effect, a study of Mitral Anuloplasty in Heart Failure patients was presented, in which 37 patients with NYHA class IV, mean ejection fraction of 16 % and at least 4+ mitral regurgitation were taken to surgery, where an anuloplasty of the posterior mitral anulus was done, without any other concomitant procedures, aiming just at correcting the mitral regurgitation. There was only one surgical death, due to right ventricular failure. After 1 year of follow up, survival was 82 %, which is a tremendous advance, as 1 year survival for class IV patients in classical medical treatment is about 30 - 50 %. Mitral regurgitation was corrected in all patients, which had a decreased need for medications.
After 2 years of follow up, the mean NHYA functional class was 1.8, with the ejection fraction in the low twenties. These attonishing results need confirmation in a larger randomized controlled study, but reasons for these apparent benefits include the favorable ventricular remodeling, like an “ Internal Batista Surgery “, where an increase in the relation mass / diameter permits a reduced ventricular workload and a better performance.
Another advance in the surgical field was the introduction of the Minimally Invasive Valvular Surgery, also presented by the Cleveland Clinic.
Laser Myocardial Revascularization received much attention.
2 ) Unstable Angina / Non Q wave AMI
5 ) Atrial Fibrilation and Atrial Flutter
Back to ACC 97
Back to Medstudents' Homepage