New surgery technique may help heart patients

NEW YORK — A new surgical technique that paradoxically strengthens the heart by cutting out a chunk of it has emerged from the Brazilian jungle, and surgeons say it could help thousands of cardiac patients lead longer, more active lives.

Dr. Randas Batista developed the method to treat his patients at the Hospital Angelina Caron in Curitiba. Many of them are afflicted by a parasitic infection known as Chagas’ disease that weakens the heart and eventually causes it to fail.

In the United States and Europe, doctors believe the procedure could benefit patients whose hearts have failed for any number of reasons, including heart attacks, high blood pressure, congenital defects or diseased valves.

“In the jungle, I don’t have much help,” Batista explained in a telephone interview. “So, once you don’t have the facilities, you always question, `Isn’t there any other way to treat this patient?”‘

That other way that Batista came up with turns out to be deceptively simple. It’s so simple, in fact, that many cardiac surgeons can’t believe it works. That’s why it has taken Batista, who has been using the method for 15 years, a long time to attract attention to it.

Heart surgeons in the United States and Europe now are excited about the technique, not only because it appears to work, but also because it fills a void in their surgical toolbox. Current treatments for heart failure include complicated and risky open heart surgery, mechanical valve replacement and even heart transplant.

“It’s such a radical approach that it’s difficult to see how this is possible,” said Dr. Tomas Salerno, chief of cardiovascular surgery at Buffalo General Hospital in New York state. “This is one of the major contributions in the history of cardiac surgery.”

In Batista’s procedure, doctors buttress an enlarged and weakened heart by cutting a piece out of the left ventricle. Restored to its proper size, the heart can beat more efficiently.

“By bringing the diameter of the heart down, one reduces the tension on the wall of the heart,” allowing it to beat more strongly, said Dr. John Elefteriades, chief of cardiovascular surgery at Yale University in New Haven, Conn.

In the United States, the operation has been tried by surgeons at Yale, Buffalo General, the Cleveland Clinic and Holy Cross Hospital in Mission Hills, Calif. Surgeons in Europe and South America also have tried the method.

Salerno said that he and his colleagues in Buffalo have performed the operation 12 times. Seven of their patients are still living. Salerno said those survivors are in much better shape than they were before the operation.

U.S. doctors diagnose about 400,000 cases of heart failure a year. A failing heart simply can’t pump enough blood to sustain itself and the body, so the condition limits activity and shortens patients’ lives. Those suffering from it must reduce their level of activity, and some are completely bedridden.

Doctors think that about 70,000 people in the United States would benefit from a heart transplant each year, but only about 2,300 of those people receive new hearts annually, mostly because there aren’t enough donors.

James Absalom, 65, of Youngstown, Ohio, is a retired grocery store manager who was a candidate for a heart transplant when he became the Cleveland Clinic’s first patient to have the surgery. He was able to go home 10 days after his May 23 operation.

“I’m feeling great. I really am,” Absalom said Friday. “I am looking forward to getting out and doing things I haven’t done for years,” including bowling and going to his grandchildren’s baseball games.

Batista has performed the operation on about 300 Brazilian patients. Approximately 60 percent of them survived a year after their surgery. That rate, which is considered good in light of the dire condition of heart failure patients, and the remarkable condition of many of the survivors, have drawn attention to the procedure.

Despite their enthusiasm, cardiac surgeons caution that Batista’s results haven’t been rigorously studied yet.

“What we have here is truly, by and large, anecdotal reports,” said Robert Michler, a heart surgeon at Columbia-Presbyterian Medical Center in New York City who is considering trying the technique.

Surgeons also noted that the technique will not benefit every heart failure patient. Heart failure can be caused by a number of problems, and many of them may be better addressed by other methods.

“It may be effective in one form of heart failure and not in other forms,” Michler said. “I’m saying, let’s do it, but let’s study it.”