Take a Piece of My Heart

THE ANNALS OF HEART DISEASE ARE full of failed treatments and faddish operations that gave desperate patients lots of hope but little help: the Jarvik-7 artificial heart, baboon-heart transplants. A new operation devised by a heart surgeon in rural Brazil seems to have just the credentials to join that dubious-achievement list. It flouts a central tenet of cardiology. Mainstream medical groups have regarded Dr. Randas Viela Batista's claims as too unbelievable to merit time at their meetings. Some 40 percent of the 300 patients Batista has operated on since 1994 have died. Most notably, news of the unusual surgery has come not from a medical journal but from a glowing segment last week on ABC's "20/20." All of which should make it easy to dismiss the procedure as cardiology's cold fusion. Except for one thing. Almost a dozen American physicians have trekked to Brazil to observe Batista's work, and they have been sufficiently impressed that four leading hospitals are now performing the experimental surgery.

Called ventricular remodeling, the operation is meant for patients with enlarged hearts due to end-stage congestive heart failure, which directly or indirectly kills almost 300,000 Americans each year. To do the remodeling, the surgeon cuts away a section of the heart wall (diagram). Although excising living tissue has long been a cardiological no-no, Batista's operation seems to provide the cardiac equivalent of a face-lift: it makes the heart tauter. That gives it greater pumping power, which means more blood and oxygen for the body.

But this is no miracle cure. Of 17 U.S. patients, six died. Of the survivors, two show no improvement. But the hearts of nine now pump more than twice as much blood as before. James Absalom of Youngstown, Ohio, is one of the lucky ones. He was languishing on the transplant fist at the Cleveland Clinic when his doctors told him about the experimental procedure and suggested he talk it over with his family. "I didn't want to talk it over," says Absalom. "I just wanted to do it!" Good call. Ten days after his surgery on May 23 Absalom was home and "feeling like a million dollars."

This surgery "could offer a viable and less expensive alternative to heart transplantation or mechanical assist devices for some patients," says Dr. Patrick McCarthy of the Cleveland Clinic. "But not for all." He suspects the procedure will benefit only patients whose hearts have been damaged not by a heart attack but by a virus. One reason for optimism is numbers: 70,000 Americans need heart transplants every year, but only 2,300 get them. Even so, a clear verdict on the operation is no sure bet. Unlike drugs, procedures do not have to be approved by the Food and Drug Administration. Cardiac patients will have to decide for themselves whether to let their surgeon take a little piece of their heart out.

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