HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Henry M. Spotnitz Eric A. Rose Daniel Burkhoff Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dickstein, M. L. Articles by Burkhoff, D. Search for Related Content PubMed PubMed Citation Articles by Dickstein, M. L. Articles by Burkhoff, D.

J Thorac Cardiovasc Surg 1998;115:262
© 1998 Mosby, Inc.

LETTERS TO THE EDITOR

Batista operation for dilated cardiomyopathy: A physiologic concept

Reply to the Editor:

As shown in Figs. 6 and 7 of our article, ¹ systolic wall stress is expected to be reduced as a result of surgical excision of cardiac mass. However, the assertion that such a reduction in myocardial wall stress a priori equates with an improvement in cardiac function, as suggested by Chandra, Kuribayashi, and Abe, is unfounded. Similarly, there may be a temptation to ascribe the increase in ejection fraction observed after mass reduction to this form of "afterload reduction." However, as we point out, this is not the case. The increase in ejection fraction is primarily due to a decrease in end-diastolic volume with little change in stroke volume. In contrast, standard pharmacologic "afterload reduction," with which clinicians are most familiar, decreases peripheral resistance and increases ejection fraction because of an increase in stroke volume, typically with relatively little change in end-diastolic volume.

We believe that a clear understanding of the underlying physiology will help guide appropriate evaluation of this procedure. Specifically, we suggest that although improvements in ejection fraction and peak wall stress may be of interest, such parameters are not likely to be the most relevant parameters to judge success of the therapy. Assessment of parameters related to clinically and physiologically relevant aspects of cardiovascular performance such as cardiac output, exercise tolerance (assessed through maximum body oxygen consumption), and, ultimately, mortality will likely be more revealing and convincing. Finally, as pointed out previously, ^1,2 there is a need to definitively define the contribution of mitral valve repair to the reported clinical benefits being observed.

College of Physicians and Surgeons of Columbia UniversityDepartments of Anesthesiology and Surgery
Cardiothoracic Anesthesia Division630 West 168th St.
New York, NY 10032 References

1. Dickstein ML, Spotnitz HM, Rose EA, Burkhoff D. Heart reduction surgery: an analysis of the impact on cardiac function. J Thorac Cardiovasc Surg 1997;113:1032-40.
   
2. Carpentier A. Does surgical reduction of heart size reduce heart failure? Lancet 1997;350:456.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Henry M. Spotnitz Eric A. Rose Daniel Burkhoff Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dickstein, M. L. Articles by Burkhoff, D. Search for Related Content PubMed PubMed Citation Articles by Dickstein, M. L. Articles by Burkhoff, D.