New heart technique debated

Dr. Randas J.V. Batista remembers what it was that first drove him to remove a strip of muscle from the heart of a dying patient to try and save her.

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"Desperation," he said Monday, sitting outside a ballroom at the Radisson Riverfront Hotel Augusta. Without the machines at his rural Brazilian hospital that would allow him to transplant a heart in 1984, Dr. Batista decided to remove a section from the ailing and enlarged heart to see if he could make it more efficient.

He is now known worldwide for the procedure, though at first it infuriated his colleagues, lost him his license and got him put under house arrest.

Now traveling the world teaching other surgeons how to do his partial left vetriculectomy technique, he saw the same desperation Monday in a patient during rounds at Medical College of Georgia, a desperation that may lead today to performing the procedure for the first time in Georgia.

"I learned a new word today -- DNR," for Do Not Resuscitate, an order dying patients can make when they don't want any heroic efforts to be revived, Dr. Batista said.

The 59-year-old patient is suffering from congestive heart failure, his heart becoming too large and too weak to pump blood efficiently. Dr. Batista, who was invited to Augusta to lecture at the Georgia Heart Institute and teach the technique, hopes to show by example. He planned to approach the patient's doctor Monday night at the lecture to see if he could perform the procedure at the Georgia Heart Institute at University Hospital.

If given permission, Dr. Batista would delay his flight out today to try and save the man's life.

"He is considered dead. He won't leave the hospital alive," Dr. Batista said. Though the operation carries a risk, "what's the alternative?" Dr. Batista said. "The alternative is 100 percent" possibility of death.

The idea would be "not only to save the patient's life but (serve) as a teaching experience for the surgeons here," he said. "By traveling and teaching, I will help them learn how to do it for their patients"

The technique is based on the idea that the diameter of the heart's main pumping chamber, the left ventricle, affects the ability to send out oxygen-rich blood to the rest of the body. It also affects the stress on the heart wall, which affects how much oxygen the heart itself uses to work.

When patients suffer from some diseases, the heart muscle weakens, output goes down and the chamber grows as the heart expands to try and keep up the pace. By removing a small wedge from the left ventricle and sewing the rest back together, the diameter is reduced the way pulling a strip out of a football and sewing it back together would make the ball smaller, Dr. Batista said.

With optimal size restored, the heart is back at its most efficient. The idea, though, has been a tough sell in the United States, Dr. Batista said.

"If you tell people you take a piece off and the heart gets better, it doesn't make any sense" to them, he said. "It's a matter of shifting the concept. These hearts are not sick. It's the diameter, it's not the muscle itself."

About 400,000 people annually suffer from congestive heart failure and about 4,000 a year register for a heart transplant. But only about half that many hearts are available for donation, said Joel Newman, spokesman for United Network for Organ Sharing, the nonprofit group that coordinates U.S. organ donations.

And the numbers do not include "thousands" more who may need them but have not been registered, Mr. Newman said.

Last year nearly 750 people died awaiting a heart transplant, about two per day, Mr. Newman said.

"For those who need a heart transplant as their only option, this could increase their chances of getting one" by helping others on the list, Mr. Newman said.

"Out of everybody that needs a heart transplant, only 1 percent will get it," Dr. Batista said.

It may be a year before Augusta surgeons take on the technique, said Lionel Zumbro, chief of cardiothoracic surgery at University Hospital and acting chief at Medical College of Georgia.

"I think you'll see it become more common," he said. The procedure may help those who are not candidates for a heart transplant because they have other medical problems, Dr. Zumbro said. An initial two-year trial on the procedure in Buffalo, N.Y., showed about 55 percent of 120 patients survived up to two years. and only 10 percent showed no improvement. Dr. Batista's two-year survival rate in Brazil is 60 percent, with all 580 patients showing some improvement. The first woman he operated on is still alive, he said.

But the numbers are phenomenal considering the alternatives these patients face, Dr. Batista said. "The cases I'm doing, in six months they're all dead" otherwise, he said.