Patrick M McCarthy MD

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Cardiothoracic Surgeon

The Cleveland Clinic Foundation Department of Cardiothoracic Surgery Cleveland, Ohio

For decades heart surgeons have opened the left ventricle to "reconstruct" the damaged heart muscle. This has typically been used for cardiac aneurysms, or areas of scarred heart muscle that bulge out when the heart contracts and cause heart failure, blood clot formation, and heart rhythm problems. In recent years, this operation has been extended beyond classic aneurysms to include patients who have damaged hearts from heart attacks and in whom the weakened heart can be improved by reconstructing the heart muscle. In most instances, the scar is removed or reconstructed, blocked heart arteries are bypassed, and leaky valves are repaired.

A highly celebrated Brazilian surgeon, Dr. Randas Batista, extended this concept to hearts damaged not just from heart attacks but also from viral illnesses, valve problems, and a parasitic disease common in Brazil. The "Batista procedure" was popularized in the United

States on many television network shows such as 20/20, NOVA, The Learning Channel, CNN, and all the network news stations. In this procedure, some of the heart muscle in these "flabby" hearts is removed, resulting in significant improvement in cardiac function in some patients. However, long-term follow-up is limited, and the results are unpredictable. Some patients had excellent results for years, whereas in others, treatment failed, and their weakened hearts required heart transplantation.

At the Cleveland Clinic, we have been working on reconstructing the heart with both the Batista procedure and also using methods for hearts scarred from heart attacks. These scarred hearts generally improve significantly after reconstruction often coupled with coronary bypass surgery and frequently with valve surgery.

Although the number of Batista procedures performed now is far less than two years ago, we think that it was a useful step along the way. We are currently developing a device that can recreate the improvements seen with the Batista procedure, but without having to use the heart-lung machine, open the heart, and cut out and remove a large portion of the heart muscle. This new device should pose a much lower risk than the Batista procedure and provide a more predictable success rate.

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