Patients with chronic heart failure don’t have many options. Although a fortunate few receive heart transplants, the rest typically live out their last days bedridden. For reasons that aren’t clear, the weakened heart thickens and grows larger, sometimes ballooning to twice its normal size. When it becomes too large, it can no longer pump effectively and eventually it fails completely. Last spring the widely viewed ABC News program 20/20 brought public notoriety to an obscure surgeon who has developed a novel way of treating an enlarged heart: he cuts a piece out of it.
Randas Batista, a cardiac surgeon in a small rural clinic near Curitiba in southern Brazil, slices a triangular chunk of muscle from the heart’s left ventricle, the chamber that pumps oxygen-rich blood to the body. Reducing the size of this dilated chamber, he explains, allows the weakened heart to pump blood more effectively. It’s the size of the heart, not the weakened muscle, that’s killing people, Batista says. When we bring the heart back to its normal size, it expends less energy and does a lot more work.
Since 1994, Batista has performed the surgery on more than 400 patients. Although he has difficulty keeping track of his rural patients, who often don’t have phones, he says his records show a 40 percent mortality rate two years after surgery. But until recently Batista’s ventricular remodeling technique was scorned by other cardiac surgeons. They thought it was a sin, says Batista, as if I was taking a piece of good heart muscle and throwing it to the cat.
In the 20/20 segment, though, three prominent U.S. surgeons journeyed to Brazil to witness the operation firsthand and came away impressed. Since May surgeon Patrick McCarthy of the Cleveland Clinic has performed the procedure on 24 patients; all but one were still living four months later. The key to success, he adds, lies in selecting patients whose heart muscle has not been so scarred that it cannot contract.
If Batista’s unorthodox procedure really works, it could extend many lives. In the United States, for example, demand for heart transplants exceeds the supply of donor hearts by about ten to one. But until more data are in, other surgeons remain unconvinced. O. H. Frazer of the Texas Heart Institute cautions, The operation shows great promise, particularly in the short term. Time and experience will show us its efficacy in the long term.