RENOWNED HEART SURGEON VISITS CAPE HOSPITAL

Dr. Randas J. Vilela Batista

The medical establishment called Dr. Randas J. Vilela Batista crazy when he proposed cutting off portions of a patient's enlarged heart to improve heart function. Seventeen years later, cardiac surgeons around the world are using the Batista heart-reduction procedure developed by the Brazilian doctor.

Batista is in Cape Girardeau visiting Dr. William Logue, a cardiothoracic surgeon at St. Francis Medical Center who was the first American doctor to perform the Batista procedure. Batista will leave tonight after two days of checking out the facilities at St. Francis and speaking to local physicians.

"He's here to enlighten the medical community about this procedure," Logue said. "We want to encourage local doctors not to be afraid to recommend this new, but effective procedure."

Many diseases cause the heart to enlarge. The Batista procedure involves decreasing the size of an enlarged, diseased heart by cutting off slices of heart muscle.

The procedure does have skeptics, Batista said.

"The concept in cardiology is that the heart enlarges to improve function. The more the heart stretches, the better it contracts, like an elastic band," Batista said.

But like an elastic band, if the heart stretches too much, it won't work as well, he said.

When a diseased heart enlarges, extra tension is placed on the heart walls, Batista said. He demonstrated the effect of that tension by inflating a rubber surgical glove. Inflated with only a small amount of air, little tension is placed on the rubber. It doesn't even leak when pricked with a pin. But blow in more air, enlarging the glove and stretching the rubber thin, and the tension increases until a prick with a pin will cause a blow out.

That increased tension makes the heart work extra hard to do its job of pumping blood, Batista said. By cutting the heart back to normal size, tension is decreased, and it is easier for the heart to pump blood.

Batista has performed more than 1,000 of the procedures in his practice in Curitiba, Brazil. He said 95 percent of his patients survive the surgery, 80 percent leave the hospital, and 60 percent are still alive two years after surgery. He said that without surgery many of the patients would have died within six months.

Even with that success rate, Batista said many surgeons remain skeptical about the procedure.

"When something new comes, it's usually met with rejection and fear," Batista said. "Rejection because it might not work. Fear because it might work."

Batista developed the method for heart reduction after returning to Brazil following medical residencies in the United States and Canada.

"In Brazil, we didn't have good hospitals with facilities and resources like you have here at St. Francis," he said. "I knew the end point I wanted for my patients, but I didn't have the resources I needed. So I used my imagination to see if there was something else I could do for these patients."

He first used the procedure in 1983 on a woman who had undergone bypass surgery but whose enlarged heart was too weak to allow her to be taken off a heart-lung machine. It was soon after he had begun his medical practice.

"She was considered dead, so we had nothing to lose by trying something different," Batista said.

He performed the heart-reduction procedure, and the woman had a successful outcome. But it landed Batista in jail. The medical establishment was appalled that this novice heart surgeon would slice off pieces of a person's heart, he said.

He was allowed to continue performing heart surgery only after promising he would never perform the procedure again. He kept that promise for 10 years. In that time, he saw many patients die who he felt he could have saved with his procedure, he said.

So in 1993, Batista, now considered a respected surgeon, again began performing the procedure. He also began promoting it at conferences and seminars around the world.

Logue learned about the procedure from a colleague who had heard Batista speak at a conference. Intrigued, Logue arranged to visit Batista in Brazil. What was scheduled as a three-day trip stretched into weeks as Logue studied and performed the procedure.

In 1995, while practicing in California, Logue became the first American doctor to perform the procedure. That patient is living without heart medication, he said.

Logue said that in the 2 1/2 years he has practiced in Cape Girardeau, he has used the procedure on 18 patients. He has about the same success rate as Batista: 95 percent survive the surgery, 80 percent go home from the hospital, and 60 to 70 percent are still alive after a year.

The other option for many of the patients is a heart transplant, he said, and 95 percent of patients die while waiting for a heart transplant. So he feels the Batista procedure gives them another option.

Not every patient is a candidate for the procedure, Logue said. Candidates are generally those patients with an enlarged heart who are experiencing heart failure with even mild exercise or at rest.

Batista said the procedure is being used in countries around the world, and because the procedure requires little specialized equipment, it is especially useful in poor countries without high-tech medical facilities.

Batista said he is proud of his pioneering work in heart reduction.

"It makes my life worth living, knowing I have made a difference," he said. "It makes me feel good as a doctor. It justifies my presence in the world."