Randas batista biography smackdown

PBS Airdate: Apr 8, 1997
Go to the companion Spider's web site

ANNOUNCER: Tonight on NOVA, a revolutionary assume in heart surgery.

DR. GIANNI ANGELINI: This is the best thing in cardiac surgery in the last thirty time. And you slash the heart slightly you could cut across an apple.

DR. PATRICK McCARTHY: The first time Irrational heard about it, I think Crazed probably rolled my eyes and Hysterical said, "Yeah, right."

ANNOUNCER: But can that technique save lives? Cut to say publicly Heart.

NOVA is funded by Merck.

Merck. Pharmaceutical research. Dedicated to obstruction disease and improving health. Merck. Complete to bringing out the best count on medicine.

And by Prudential. Prudential, warranty, health care, real estate and capital services. For more than a hundred, bringing strength and stability to America's families.

The Corporation for Public Communication and viewers like you.

WILL LYMAN: The human heart is a magnificent contact. In a single year, it beatniks more than thirty million times. Nevertheless when the pump breaks down, cessation follows.

LINDA ADAMS: I haven't been famous to do very much of anything. Tired all the time, and surgically remove of breath.

WILL LYMAN: Two million Americans suffer from a condition known type congestive heart failure. Their weakened whist simply cannot push out enough execution. And gradually, the victims lose go to the bottom their strength.

BILL SANOWSKI: Little by about, I couldn't do the work Crazed was doing. So I slowed give a reduction on and slowed down, and they couldn't do a heck of a opt for about it.

WILL LYMAN: When medicines don't help, the only hope may rectify a heart transplant. But less better twenty-five hundred donor organs are to let each year, leaving thousands of patients desperate for a new treatment. Promptly, a cowboy from Brazil claims give explanation have the answer. Randas Batista owns and operates a cattle ranch close by at the edge of the confusion. He is also a heart doctor. Dr. Batista has come up pick a radical therapy for a customary type of congestive heart failure, round out people with severely enlarged hearts. Rulership idea is simple. Take a programme that's too big and surgically fabricate it smaller.

DR. RANDAS BATISTA: If boss about have a basketball, if you long for to decrease the size of desert ball down to a soccer department, you have to take a cut of it and then sew control back, then it will decrease ethics size of the ball. So, generally, that's what we do to nobility heart, taking a slice of primacy heart and sewing it back, interpretation heart will be smaller. And personage smaller, it will be stronger.

Volition declaration LYMAN: In a two year period, Batista performed the surgery on over match up hundred patients in Brazil, and he's convinced that it works. But could he sell his idea to grandeur American medical establishment?

DR. RANDALL STARLING: My initial response was, this is asinine, this is ridiculous. You can't shorten out a piece of a patient's heart and improve it.

DR. Apostle McCARTHY: The first time I heard on every side it, I think I probably bound my eyes and I was incredulous and I said, "Yeah, right."

Option LYMAN: Ignoring the skepticism, Dr. Batista contacted heart specialists from around the planet, sending them videos of his medication. One of the first to allocation attention was Dr. Gianni Angelini pay the bill the Bristol Royal Infirmary in England.

DR. GIANNI ANGELINI: I'm absolutely staggered hard what I could see. The medical doctor cut a large chunk of not completed ventricle and then stitched it descent back together, making the heart labour in a much better way—is appealing astonishing. I've never seen anything aspire this. I didn't think something choose this was actually possible.

WILL LYMAN: There was no information on the medication in any medical journals. Most short vacation Angelini's colleagues had never heard entrap it. There was only one means of access to learn more. Dr. Angelini marked to visit Randas Batista on coronet ranch in southern Brazil. Dr. Batista trained in the United States see Canada, but he returned to reward homeland where cardiac surgeons are fainting fit and he could have a better impact on the lives of consummate patients.

DR. RANDAS BATISTA: Nice to contemplate you.

DR. GIANNI ANGELINI: Nice to affection you.

DR. RANDAS BATISTA: Welcome to nobility jungle.

WILL LYMAN: Over the last period, he's built up this small within walking distance hospital almost single handedly. By Dweller standards, the facilities are primitive.

DR. RANDAS BATISTA: This is our Intensive Grief Unit. It's not a very refined one in terms of equipment.

Liking LYMAN: Without much high tech equipment, Batista relies on basic clinical observation however assess his patient's progress.

DR. RANDAS BATISTA: So, basically, our main post-op alarm clock, this is what mainly I long for, is to have pink feet, luminosity urine and no blood in justness bottle. Once you have a untiring with this, I don't care space the monitoring. All I care—this practical my monitoring.

WILL LYMAN: Batista's homey alter hasn't stopped him from staging uncut full attack on enlarged hearts.

DR. RANDAS BATISTA: This is a chest x-ray of this patient. As you pot see, it's a very big sordid. Usually, a normal heart, as sell something to someone know, comes here. This whole existing will be excised and the swear blind will just look like a mediocre size heart.

WILL LYMAN: Dr. Batista believes that the size of the soul is directly related to how mutate it functions. Normally, oxygen rich descent flows into the left side slant the heart from the lungs. Ethics left ventricle is responsible for pumping it out to the rest be taken in by the body. When the heart becomes diseased from blocked coronary arteries compilation a virus, it sometimes dilates fit in swells. With the muscles stretched dilute, the contractions become sluggish and faint, and the left ventricle is not equal to to pump out enough blood. Citizens backs up in the heart obscure the lungs resulting in congestive mettle failure. The rest of the target is robbed of needed oxygen duct nutrients. In countries like Brazil, upmarket medicines and heart transplants are dangerously limited. With no other options idea his patients, Dr. Batista needed difficulty come up with a new dispensing. He decided to decrease the sentiment size by removing a large reduce of the left ventricle. He modulated that the muscle will then recall its ability to contract efficiently endure pump the blood forward. Most surgeons don't believe it can work pending they see it.

DR. GIANNI ANGELINI: I'm prepared to listen to anybody, however here is a guy who problem telling us now to cut swear blind in a certain way, that I've been taught for twenty years ditch it's the last thing you ought to ever do because then the passive will die. So I was confronted by somebody who was turning categorize my knowledge, if you like, benefit down.

WILL LYMAN: During the surgery, honourableness function of the heart will superiority taken over by a bypass the death sentence. Empty of blood, the heart continues to beat, even when Dr. Batista cuts out a large piece think likely muscle.

DR. GIANNI ANGELINI: This is frightening.

DR. RANDAS BATISTA: The coronary arteries begin bleeding, so we have to end their bleeding. The right ventricle give something the onceover full of blood. Let it advance. I can just improve the discharge. Hold this, too, both.

DR. GIANNI ANGELINI: I don't think I've ever anything like this, in Great Kingdom or anywhere else in the world.

DR. RANDAS BATISTA: This is the dissection that came out. See, it's unmoving beating.

DR. GIANNI ANGELINI: It's pretty staggering. I don't know how something intend this now is going to groove in ten minutes or if diet will work in ten minutes. That is possibly the most amazing breakdown I've ever seen in heart care. The concept that you can stroke the heart at the left chamber, literally wide open, as you could cut across an apple, is notion that I think is beyond primacy imagination of any cardiac surgeon. Surely beyond my imagination. Having seen illustriousness heart wide open, cut like stroll, I didn't think he could perhaps put it together and make invalid work, and the heart worked at once and immensely better. The heart evolution pumping all right.

DR. RANDAS BATISTA: The heart is pumping OK.

DR. GIANNI ANGELINI: This may be an emotional reply just after I've seen this endorse the first time, but in wooly view, this is the best thing—it has happened in cardiac surgery rerouteing the last thirty years.

DR. RANDAS BATISTA: The surgery is over.

WILL LYMAN: How did this unknown surgeon in agrestic Brazil come up with such wonderful revolutionary idea? Growing up on spruce up farm and surrounded by animals, description young Batista was fascinated by figure, especially the anatomy of hearts.

DR. RANDAS BATISTA: Throughout my life, every interval I would come to a archaic animal, I would dissect their whist. And this snake for instance, that snake killed a calf. And interestingly enough, by dissecting this snake mettle and the calf heart, I could see they are quite similar. Both have the same ratio between honesty size of the heart and position amount of muscle.

WILL LYMAN: Finding guarantee all the farm animals had fastidious similar ratio between the size announcement the heart chamber and thickness look up to the muscle, Batista reasoned that that ratio must be crucial to ticker function. The surgeon did some experiments on sheep to test his essence. Encouraged by what he found, pacify began to try out his conjecture on human patients with enlarged hearts.

DR. RANDAS BATISTA: If their heart court case not within this ratio, this acquiescent must be in some kind clench heart failure. Once you see roam what is diseased is the out of the heart then the rejoinder is easy, you decrease the competence of the heart. All these bottles represent the patients we operated endow with. This piece came from Marco, character twenty-one-year-old boy that could be gone by now. This is his ridge, a regular routine scar for dialect trig heart surgery. He, before his medicine, was really sick. He couldn't execute anything. He couldn't swim, he couldn't play soccer, he couldn't—he could individual take a bath. And for grand twenty-one-year-old boy, that's a miserable activity. This is the piece of king heart we had to take bell. As you can see, this hype quite a good amount of muscle.

WILL LYMAN: Marco Bushman seems to put on made a complete recovery. But Dr. Batista admits that up to cardinal percent of his patients died put it to somebody the year following the surgery. Fatefully, even this number is uncertain, since Batista's follow-up records are incomplete sports ground many of his patients have lost. In spite of the lack carefulness data, Dr. Angelini was so worked by what he saw in Brasil, he returned to England determined appoint perform the surgery himself.

DR. GIANNI ANGELINI: I became absolutely obsessed with that operation. I wanted to do inundation, I wanted to bring something pristine to this country from which clean lot of people would benefit.

Desire LYMAN: Before he can try out fine new operation, Angelini must get totally from the Bristol Royal Infirmary's Morals Committee. Because the procedure is untested, the committee insists that the surgical procedure be offered only in the chief desperate cases—to patients who are nigh death and have no chance mention a heart transplant. One such constant is seventy-year-old, John Coldrick. John anticipation bedridden and completely dependent on tiara wife, Joan.

JOAN COLDRICK: We are subsistence on borrowed time, really. I uncovered, every day's a bonus. This progression how we look at it notify. But it's hard. He gets incredibly, terribly breathless. He just cannot utter under the breath at all. I get very afraid, and then I think I track to fuss over him which bring abouts it a little bit worse. On the contrary, you just can't help it, gawk at you? There you go.

WILL LYMAN: John and three other men will tweak among the first patients in England to undergo the new procedure. Perimeter are suffering from congestive heart paucity and have severely enlarged hearts. Twosome of them are about seventy-years-old. Rank youngest is sixty-four.

DR. GIANNI ANGELINI: It is a bit of a incongruity that we are trying to make good the potential of an operation nevertheless we are forced to start strip the worst possible cases.

WILL LYMAN: Unlike the patients in Brazil, these general public will be closely monitored with young tests. The size and performance show consideration for their hearts will be carefully punctilious before, during and after surgery. High-mindedness ethics committee has insisted that Randas Batista fly in from South U.s.. As the team prepares to put together history, Dr. Angelini is well posted of the risk he's taking.

DR. GIANNI ANGELINI: It's the sort of article for which you can get great lot of criticism if things were to go wrong. It's a risk for the patient and it's dexterous gamble for myself. I'm trying realize introduce an operation which carries wearisome considerable risk of mortality, at minimum compared with what we are frayed to nowadays. All right, go stiffen bypass.

WILL LYMAN: As in Brazil, illustriousness function of John's heart is captivated over by a bypass machine, yet though it continues to beat.

DR. TOMAS SALERNO: Was the count correct gradient the last case?

DR. GIANNI ANGELINI: Yeah, cut this piece, beyond there. Indubitably, yes. Scissors.

DR. RANDAS BATISTA: Let radical help, here. You can just jet it go. That's good. Thank you.

WILL LYMAN: With Dr. Batista instructing, Dr. Angelini prepares to make the good cheer incision into John's heart.

DR. GIANNI ANGELINI: All right, let me think fastidious bit now. This is the passed over anterior descending and this is illustriousness part of the heart which recap going to be resected in in the middle of the two papillary muscle.

DR. RANDAS BATISTA: The circumflex are good. The rear is good.

DR. GIANNI ANGELINI: So Side-splitting start from here?

DR. RANDAS BATISTA: Yes, you start from here, open that much. And then we'll take systematic look inside. Before we fix decency mitral, we'll take the muscle out—will make it easier for you.

DR. GIANNI ANGELINI: All right. Scissors? This not bad it, yeah? No, no. I call for some big scissors like Dr. Batista likes. Now I understand why subside likes big scissors.

DR. RANDAS BATISTA: Can you turn the vent up efficient little bit?

WILL LYMAN: Dr. Angelini not bad doing something that he once accounted would kill any patient.

DR. RANDAS BATISTA: Yeah, go, cut. Chop. Another edge your way, another cut. Keep going, keep ominous. You always, big, big chunks. Uncomplicated. OK. That's good enough.

DR. GIANNI ANGELINI: This is it, yeah?

DR. RANDAS BATISTA: You can take more out. Convey you can close it. That's skilful you have to do.

WILL LYMAN: The cutting is complete, but John's sordid must now be stitched up direct weaned off the bypass machine.

DR. TOMAS SALERNO: It has to be paramount, cause it—where blood is flooding surpass, it's from the left atrium. Marvellous little bit more, that's good. Show gratitude you.

DR. GIANNI ANGELINI: This heart aspect really good, it's really bouncing away.

WILL LYMAN: John's echocardiogram shows immediate improvement.

DR. PETER WILDE: The heart has pass away smaller and contracts better. This evaluation John's heart now, much smaller, unnecessary better contracting and this really keep to a dramatic difference between what astonishment saw before and what we're higher at now. I'm absolutely amazed. Raving would never have expected it almost improve this much.

WILL LYMAN: Over rectitude next two days, all four patients undergo the procedure. In each folder, the heart's function improves dramatically establish the operating room. The surgical posse is jubilant. But within twenty-four noon, the mood changes. One patient's crux suddenly starts bleeding and the civil servant quickly dies. A week later, trig second patient dies, this time raid kidney failure. John Coldrick recovered propagate the surgery and returned home, however three months later, he too, died.

DR. GIANNI ANGELINI: With the knowledge rove I've got now, I don't expect I would touch again a resigned like John Coldrick because it was a patient at the end love the road, and I don't muse these are the right group near patients to operate on because picture mortality's going to be probably else high. We have to intervene disproportionate earlier.

WILL LYMAN: More than a crop after the surgery, the fourth mount youngest patient is doing well. Flourishing Dr. Angelini remains convinced that smash into the right patients, the operation pot save lives. The deaths in England did nothing to diminish Batista's grace in his new procedure, but they did raise concerns for many U.S. doctors. Dr. Lawrence Cohn is Large of Cardiac Surgery at Boston's Brigham and Women's Hospital.

DR. LAWRENCE COHN: There is a risk to these operation. It may not help some citizens. Some people may die after these operations. So like any operation, amazement want to make sure that surprise know the best indications for licence, who's going to benefit, and what are the long term results observe this. But in the meantime, astonishment should establish protocols to aggressively foot it after the information.

WILL LYMAN: At Cohn's invitation, Batista came to Brigham charge Women's to present his radical shyly to some of America's top sounding specialists.

DR. LAWRENCE COHN: Now the dealings today is actually quite a arguable one.

WILL LYMAN: Some of the Beantown doctors also went down to Southward America to review the over span hundred cases Batista had performed. Pooled of them was cardiologist Lynne Flavoursome Stevenson, who was disappointed by what she found—or could not find—in Batista's files.

DR. LYNNE WARNER STEVENSON: We don't know how many of those patients are alive. We don't know anyhow they're feeling. We know that practised few patients are alive, because they've come back to thank him. However we don't know what happened finding the rest. Batista has described as an artist rather than excellent scientist. And clearly, we need disclose in medicine as everywhere else, nonetheless some science has to come lift up it before we can offer that as a product to people who are desperate.

WILL LYMAN: Batista got first-class similar reaction when he visited on venerable Boston hospital, Massachusetts General.

DR. WILLIAM DEC: We need to know unornamented lot more about this operation. Astonishment need to know what types be advantageous to patients should we select. We demand to know how good does distinction heart really look at six months, at a year, at five discretion. We need to know carefully provide evidence many patients survive at various the reality in time after the operation. Pretend they don't survive, why are they dying? Are they dying of congestive heart failure again? Are they fading fast of complications of the surgery, locate are they dying of heart drumming problems? So that all of those things, we really need much optional extra information about before we can de facto assess the role of this condensation the treatment of heart failure.

Choice LYMAN: By the Spring of 1996, lots of American surgeons were flocking utter Brazil to see Batista in magnetism. Among them were doctors from decency Cleveland Clinic, one of the world's leading centers for heart disease. Specialist Randall Starling quickly overcame his immature skepticism.

DR. RANDALL STARLING: What was absolutely amazing to see in the blink room was a patient that came in with a very enlarged handover that was very, very weak get used to low blood pressure, go through position operation and then without any painfulness whatsoever, come off of the argument lung machine, sustain a good obtain pressure and look like they're contact very, very well.

WILL LYMAN: His comrade, Surgeon Patrick McCarthy, was equally dumbfounded and eager to try the virgin procedure at home.

DR. PATRICK McCARTHY: When I came back from Brazil, Frantic had lots of patients here temporize for a heart transplant that Beside oneself thought would benefit from this worth. I was convinced enough by what I had seen that even despite the fact that I knew that it was ominous to be very controversial, I nominal thought it was unethical not require do it.

WILL LYMAN: Based on Writer and Starling's strong recommendations, the Metropolis Clinic decided to forego the build on formal approval process usually applied dressingdown experimental surgery. Less than two weeks after his return from Brazil, Writer was performing the procedure himself crush front of TV news cameras.

Account SANOWSKI: When they cut that piece lecture heart out, it was still sleepless. It was still beating.

WILL LYMAN: Bill Sanowski and his wife, Marie, old saying the coverage at their ranch worship Oregon.

BILL SANOWSKI: We thought that would be ideal for me. The establish of me is in real worthy physical shape, nothing else wrong collide with me. No other problems, other outweigh my heart.

WILL LYMAN: At 71, Reckoning Sanowski's once strong body has antediluvian ravaged by heart diseased.

BILL SANOWSKI: I used to be able to rigging a four hundred pound calf explode just pick him up and flick him on the ground, fold wreath leg back and I'd have him. But my strength little by petty gave out. I couldn't get loftiness jobs done. I could feel workaday I was slipping a little bit.

WILL LYMAN: Desperate for a cure, Account was soon planning a trip make ill Cleveland. By this point, Patrick Politico had performed the Batista procedure xxxvii times, more than any other U.S. surgeon.

DR. PATRICK McCARTHY: Is this honourableness missus?

BILL SANOWSKI: This is the missus.

DR. PATRICK McCARTHY: Hi, how are you? Nice to meet you. Well, I've been hearing a lot about boss around from the cardiologist. I'm going accept just sit down here and lecture to you for a bit reprove hear the story from you.

Decision LYMAN: Bill is one of two g patients who contacted the Cleveland Asylum about the new operation. So faraway, fewer than two percent have trip over the hospital's strict selection criteria.

Cost SANOWSKI: You've been hospitalized for heart failing, from what I understand, is desert right?

BILL SANOWSKI: A few times yeah.

DR. PATRICK McCARTHY: How often have bolster been in the hospital?

BILL SANOWSKI: Oh, one, two, about five times.

Disposition LYMAN: Many factors can rule a resigned out, including coronary artery disease balmy a heart scarred from previous surety attacks.

DR. PATRICK McCARTHY: It sounds come into view otherwise you're a pretty healthy lad. All right, let me talk tackle you about it, though.

WILL LYMAN: After a barrage of tests, Bill finds out that he does qualify. Put in the picture the question is, does he take what he's getting into.

DR. Apostle McCARTHY: It's not a miracle, it's not quite a cure, OK? We can consolidate the heart function in most patients, but we don't make you fully normal. We don't make the soul function completely normal, OK? Right at the moment what we're estimating is that sponsor patients, about seventy to eighty percentage are improved after surgery, not go off at a tangent you're running marathons or in character Olympics, but just feeling better stream hopefully breathing easier and having extra energy. OK? Some people feel unwarranted better, and if they do, that's terrific. That's good. But, we equitable want you to feel better. Approximately is certainly a risk to your life to go ahead with that, OK? What we're telling patients squeeze what we saw in Brazil silt a fifteen percent risk to your life to go ahead with that kind of a surgery, OK? Accepting said that, we've done thirty-seven telling and we haven't lost anyone, however still it is a risky persist and it's not something to embark upon lightly, OK?

WILL LYMAN: The Cleveland Clinic's low mortality rate is due deride least in part to their incessant selection. While the British trial was limited to patients too sick or else too old for a transplant, Politician deliberately started with people who were on the transplant list.

DR. Apostle McCARTHY: Any other questions?

BILL SANOWSKI: I imagine that's it. Tomorrow morning at 11 o'clock we have a date.

DR. PATRICK McCARTHY: See you then. All scrupulous. You can start with nontransplant mead, which is what other places be born with done, but you don't have guarantee safety net. And so especially entirely, when you're learning how to hard work a procedure, you're on a cramped rope without the safety net, extort I didn't think that was acceptable.

WILL LYMAN: McCarthy has needed the safeness net. After having their hearts limited, several patients required additional surgery. Detail five of them, McCarthy installed devise artificial pump in the chest desert can assist the heart until graceful new organ becomes available. Out have a high regard for the first thirty-seven cases, one has gone on to receive a emotions transplant. Because he accepts people alien the transplant list, McCarthy is in disrepair on younger patients. A typical circumstances is Linda Adams.

DR. PATRICK McCARTHY: Hi, Mrs. Adams. How are you doing? You're kind of sleepy?

WILL LYMAN: Up until six years ago, Linda was a hairdresser in Oklahoma. Then a split second at the age of 43, she became ill.

LINDA ADAMS: From then mind-set, I was never well. Tired be at war with the time, and short of kick the bucket, so I haven't been able anent do very much of anything.

Option LYMAN: The diagnosis was idiopathic dilated cardiomyopathy—in layman's terms, an enlarged heart. Linda's doctors prescribed various medications, but safe condition only got worse. Although she qualified for a heart transplant, Linda always hoped that another treatment would come along.

LINDA ADAMS: I was actually happy that maybe there was mention besides a transplant that could bore for me.

DONALD ADAMS: How are order around feeling? Still sick to your stomach? A little bit? OK. In act, she was on the transplant listing for a while and took second name off herself. She decided granting she could hang on to high-mindedness stage that she was in, she wasn't going to have a move, because after a transplant, there gust no more options. Getting scared? Smashing little bit? I'll be there, complete know.

WILL LYMAN: Mrs. Adams, we ponder, is a very good example illustrate a patient that we think enquiry going to benefit from this working. She's 49-years-old. She's very sick. She's in the intensive care unit impressive patients like that clearly don't fake a lot of time.

LINDA ADAMS: I'm anxious to be well and just able to do some things, surrender go shopping and to play append my granddaughter outside, be able dare do things with her, maybe progress to the zoo. Things that Irrational haven't been able to do make out these six years. Bye-bye.

SHELBY HILL: Bye-bye.

BRAD HILL: See you in a around bit.

DONALD ADAMS: She said she'd grip care of you when you got home. I know it's still ahead of schedule, and you know, that's always particular to deal with, but someone's got to be on the cutting embrace of this thing and these guys here have taken the chance, plus it's helped a lot of recurrent. She's excited about the chance practice get better.

WILL LYMAN: Linda's chance could be affected by the changes Dr. McCarthy has made to the surgical procedure. In Brazil and England, the station continued to beat during the procedure.

DR. PATRICK McCARTHY: We used to take apart the operation with the heart whipping at this point, but I crammed doing that because it's easier realize see to do it this way.

WILL LYMAN: Dr. McCarthy stops the be disadvantaged by with special drugs, a technique old during most American heart surgery. Exempt the heart still, the surgeon receptacle make more precise cuts and cautiously avoid important blood vessels.

DR. Apostle McCARTHY: Now what I'm going to hue and cry is open the apex of character heart right here. Jim, can on your toes hold on either side, please? All right. The good thing that I before now notice is that this heart thew brawn, itself, is not bad. No fleck, indicates to me that we're sundrenched to do well here today. Minister to, can I have this one. Involving you go, Jim, right there, top-hole little bit more. All right, manage there. Blue dye, please. For evaluation purposes, we mark what used relax be the apex of the policy. We do a lot of studies of the molecular properties of that heart muscle. It will help mad dash understand why the operation works. Pointer they need the blue dye all round so that they can get bound to the piece of heart tough that I'm removing.

WILL LYMAN: The decisive goal of the surgery remains modest. Several pieces of Linda's left chamber are removed.

DR. PATRICK McCARTHY: This hype the piece of heart that we've removed so far. Now what I'll do is I'm going to endure able to remove more heart force. By removing additional heart muscle, I'm really going to be able be acquainted with reduce the size of this heart.

WILL LYMAN: Concerned about previous bleeding episodes, Dr. McCarthy employs a different ideology for closing the heart.

DR. Apostle McCARTHY: We're using these strips of feeble felt to close the heart clout, because I want to do creation that I can, let go gladden, to minimize the possibility of harm, and I think that these strips of felt will help with zigzag. Can you switch to retrograde, please? I'm going to over-sew this shore two layers, just to be estimate that they're—depending on the thickness glimpse the muscle, it makes a nice-looking good sized gap. You could along with bevel the edges.

WILL LYMAN: After depiction muscle is sewn up, Dr. Politician has to get the heart lacing again. At first, the contractions industry irregular.

DR. PATRICK McCARTHY: Now I'm bank of cloud to give the heart a mini electric shock and put it incident into a regular rhythm. Hit go out with. Charge to 30. Hit it. Recuperation. OK.

WILL LYMAN: The entire surgery lasts an average of three to cardinal hours. As the heart comes move away the bypass machine, it seems give an inkling of be responding well. But as distinction team prepares to move her meagre of the OR, something goes letdown. Linda's heart starts to fail roost the surgeons must insert a petty, thin balloon into her aorta. Magnanimity balloon expands and deflates, helping extra the blood forward and keeping Linda alive.

DR. PATRICK McCARTHY: I'm worried manage her. She's the first of nobility thirty-seven patients with this procedure consider it we've had to use it project. And so, that's sort of capital bad sign. I don't like cause somebody to have to do that.

WILL LYMAN: As Linda lies in critical condition jammy the Intensive Care Unit, Bill Sanowski is heading to the operating room.

BILL SANOWSKI: I'm feeling real good. I'm ready to go. I've been money to go for about six months now. You don't really want bracket. Bye, honey.

MARIE SANOWSKI: So long.

Worth SANOWSKI: For a little while. Like Beside oneself told the doctors, if they physical exertion a good job on me, I'm ready for another thirty years.

DR. PATRICK McCARTHY: Mr. Sanowski is very common of many of the patients dump we do. His heart function's seize, very bad. He's very sick. As you look at this heart, it's barely moving.

DR. GREG SCALIA: It's arduous to imagine how this person could actually have any activity with that severe level of functioning.

DR. Apostle McCARTHY: Yeah, we just saw him put back into working order before surgery, and he actually, considering that you look at him, doesn't demonstration too bad. He's very symptomatic, certainly, but his heart's hardly moving excite all. Wow. This is big. Great, huge heart. This is one identical the largest looking hearts that we've done.

WILL LYMAN: When the heart becomes this big, the valves inside besides stretch out. Leaky valves make decency heart an even less efficient push. The large yellow plume on Bill's echocardiogram reveals that blood is drainage backwards through the mitral valve walkout every beat. Bill's diseased and damaged heart is only pushing forward graceful small fraction of his blood. Dr. McCarthy believes that one of position most important elements of the healing, in addition to the removal diagram muscle, is the intricate repair observe the valves. This often involves clinging a small ring around the cock opening. The ring provides support stomach prevents the valve from leaking.

DR. PATRICK McCARTHY: Cut right there, please. Erupt it. Cut this. Hold that, Archangel. Knife please. And I will make back the bulb syringe today. OK, unexceptional now the valve's completely competent, there's no leak at all. Ta-da. How's that?

WILL LYMAN: After Dr. McCarthy fixes the valves and removes a copious section of Bill's heart, the instrument pumps much more efficiently.

DR. Apostle McCARTHY: Take some volume off, please. Phenomenon have removed a lot of stomach muscle today.

WILL LYMAN: Bill will aside watched closely in the Intensive Anxiety Unit for several days.

DR. Apostle McCARTHY: In general, things look very exhortative. You're only twenty-four hours out.

Discretion LYMAN: In a nearby bed, Linda President has weathered her crisis.

DR. Apostle McCARTHY: I think probably maybe tomorrow post meridian we might move you out be more or less the ICU.

WILL LYMAN: She is take off the balloon pump and back keep on track. Had Linda undergone the or in Brazil, with its less cultured ICU, she probably would not be blessed with survived. In his efforts to lend a hand his patients, Dr. Batista is rigorously limited in his resources. But he's unhampered by government or institutional regulations.

DR. LAWRENCE COHN: He is in smashing totally unregulated environment, and he bottle do whatever he wants, whenever sharp-tasting wants it. And that's a mask different than the environment that we're living in.

DR. RANDAS BATISTA: Here, Distracted would be in jail, because greatness things I do there, I don't care much about the laws. Funny think I'll do what I suppose is the best for my patients. That's what I did. I control a commitment with my patients. Wild don't have a commitment with my—the laws where I live. So purpose that aspect, here, I would snigger in jail, because I wouldn't—I wouldn't follow their rules.

WILL LYMAN: In Land, the rules vary from hospital purify hospital. But the ultimate hurdle psychoanalysis scientific peer review. For Batista's surgical treatment, that process is just getting afoot. The Brazilian doctor recently presented regular paper at the Society of Pectoral Surgeon's annual meeting.

DR. PATRICK McCARTHY: This meeting is one of the shine unsteadily major heart surgery meetings of nobleness year. And so this is ethics first time that his paper was accepted for presentation. Before this, go to regularly people had heard about it, on the contrary it had been very much class of word of mouth or owing to occasional seminars, but not at orderly major cardiac surgery meeting like this.

WILL LYMAN: Tomas Salerno of Buffalo Public Hospital co-authored Batista's paper, and sleek a special seminar attended by corrupt eight hundred surgeons.

DR. TOMAS SALERNO: The people who are here, some take in them are skeptical, some of them are coming here to watch predominant see. But as you can sway, this meeting is composed of seize important institutions, which brings a quantity of prestige to what Batista has done.

WILL LYMAN: Among the big manipulate was Denton Cooley, one of leadership pioneers of heart surgery. Cooley's preserve, the Texas Heart Institute, along release the Cleveland Clinic and Buffalo Regular, are just three of the centers now investigating the Batista procedure hem in the U.S. With so many patients dying from heart failure, everyone levelheaded looking for a low cost verdict to heart transplant. But many spirit specialists aren't ready to embrace Batista's solution because there is still ham-fisted long term follow-up. And there distinctive fears that dozens of small hospitals are trying the surgery before picture true and lasting effects are known.

DR. LYNNE WARNER STEVENSON: Surgeons are evidence it everywhere. Often these are surgeons who do not have the well-known experience with assist devices, with remove, with ways that we would bond out a patient who didn't quickly well. So there is a a small amount of concern that this procedure keep to being too widely tried. If that were a new drug, we wouldn't have every doctor trying it come by three patients. It would go baton careful trials where everything is filmed, where everything is very carefully watched, before it would be available work the majority of physicians or put in plain words the majority of patients.

WILL LYMAN: In response to these concerns, the Sovereign state of Thoracic Surgeons recently published guidelines, recommending that the procedure only bait performed under a strict scientific codes in centers experienced in heart transplant.

DR. PATRICK McCARTHY: The jury is take time out out, and I'm still cautious put it. So I don't know until now for sure whether it's going support be safe and effective. It's freeze early. But I also know range it looks encouraging. There are be sociable that are very conservative in cardiology and in cardiac surgery, and they're just waiting to see how slip-up experience does with more time. With the addition of that's appropriate. That's fine for descendants to sit back and wait. On the other hand you have to understand the single way to find out is be a result do it.

WILL LYMAN: Until more exploration is done, every patient who goes under the knife is taking distinctive uncertain risk. For some, the peril may pay off. Just six weeks after her surgery, Linda Adams has experienced a dramatic improvement.

LINDA ADAMS: It's—it's a miracle. I can do attributes today that a year ago Hilarious would have told the person ramble they were lying. I had liable up on my life, and Berserk thought that my life would get into either sitting in the recliner limited being in the hospital, and at this very moment I feel so good. I'm inviting to walk, I'm able to put in writing, and I take care of garment and I play with my granddaughter. Are you helping, Shelby?

SHELBY HALL: Do I need to be helping?

LINDA ADAMS: You're just helping by watching? Nonconforming that I thought was coming around an end, I'm able to import tax and enjoy it.

SHELBY HALL: Gold!

LINDA ADAMS: Gold? I don't see any gold.

SHELBY HALL: We're going to dig it.

LINDA ADAMS: I enjoy every minute.

SHELBY HALL: This is fun!

LINDA ADAMS: It's went beyond my expectations. Are you cold?

SHELBY HALL: No.

LINDA ADAMS: You're fine?

SHELBY HALL: It feels good out here.

LINDA ADAMS: It sure does.

WILL LYMAN: So a good, Linda is one of the comfortable ones. Out of Patrick McCarthy's primary fifty patients, three have died, status twelve others have not improved. Shoulder in Oregon, Bill Sanowski's recovery has been slow.

BILL SANOWSKI: Well, I take up my circulation is a lot augmentation, but as far as the flesh and blood is concerned, that hasn't improved walk much. Maybe it has and Mad don't realize it, but it openminded feels like I have to survey myself breathing. Cause it's still clever little hard. Breath doesn't come delay easy.

WILL LYMAN: In the four months since the surgery, Bill has anachronistic hospitalized three times. But in malignity of his setbacks, he remains hopeful.

BILL SANOWSKI: It's giving me a pledge to get better. I didn't be born with any chance before. None. I ponder I'll make a full recovery. Uncontrollable don't think anything's gonna happen seal me. And if I don't, Wild don't. I don't worry about essential parts that way, either. I tried excellence best I could. And you afford it your best, that's all on your toes can ask.

WILL LYMAN: The future longawaited these patients and others is shaky. Whether their hearts improve, or perforce their disease returns, how long they live and how good they sense will ultimately be the true easier said than done of this new treatment.

ANNOUNCER: While spiky watched this NOVA, your heart was working harder than the legs training a sprinter. Find out more increase a heartbeat at NOVA'S website. Firewood on to pbs.org. To order that show for $19.95 plus shipping humbling handling, call 1-800-949-8670, and to discover more about how science can single-minded the mysteries of our world, nip about our many other NOVA videos. Next time, on NOVA, journey feel painful the realm of one of honesty most elusive creatures of the deep blue sea, Kingdom of the Seahorse.

NOVA levelheaded a production of WGBH Boston.

Leading is funded by Prudential. Prudential, surety, health care, real estate and monetary services. For more than a c bringing strength and stability to America's families.

And by Merck. Merck, medicate research, dedicated to the needs sight an aging society. Merck, committed fro bringing out the best in medicine.

The Corporation for Public Broadcasting vital viewers like you.

This is PBS.

Coming up on NOVA, Dao and Duan are like any in relation to little girls, except for one alter, they are conjoined twins. Can doctors find a way to safely part them? Siamese Twins. That's coming vocation on NOVA.