Neither of the standard therapies for congestive heart failure--drugs and heart transplant--has proved particularly effective. Medications such as ace inhibitors keep the body's blood pressure down, making it easier for a weakened heart to circulate blood, but they do not fix the organ. In late-stage heart failure, the only option is a heart transplant. But while as many as 50,000 people in the U.S. alone need a heart transplant, only 2,500 transplants are performed there each year. Heart transplants have proved quite effective, with mortality rates of only 20% after a year (but 20% to 30% of patients die while waiting for a donor). For those deemed unsuitable for a donor heart--some of the elderly or those with chronic diseases like AIDS or cancer--there is little hope.

The situation is even worse outside the U.S. and Europe. In many countries, heart transplants are virtually nonexistent because of the lack of facilities for performing the procedure. But the facilities are not always the problem. In Japan, for instance, people are not pronounced dead until the heart stops, and then it is too late to donate the organ. (In the U.S., heart donations are possible because death is pronounced when brain activity ceases.) Dr. Torao Tokuda, chairman of the Tokushu-Kai Medical Corp., owner of 40 hospitals and 70 clinics in Japan, plans to spread the Batista procedure to all his facilities. Says one of his top surgeons, Dr. Hisayoshi Suma: "This surgery is of great importance worldwide."

While his operation goes against the general thinking in cardiac surgery, Batista believes he is just respecting nature's laws. He developed his ideas by studying the hearts of animals he found on his horse farm near the Angelina Caron Hospital, where he works. To his astonishment, the heart of every animal he examined, from snake to buffalo, had the exact same proportion of muscle mass to heart size. He found that the relationship came down to a simple equation, loosely based on the law of La Place: mass = 4 x radius3. For every centimeter that it enlarges, the heart needs an enormous amount of muscle mass to compensate. Batista reasoned that since nature had decided on a perfect proportion for hearts, his job was to bring enlarged hearts back to their ideal size. "Is this a miracle?" he asks. "No. We're just creating a more efficient machine."

The conditions under which Batista, 50, operates when he is in Brazil are spartan at best. There is little modern monitoring equipment at his Curitiba hospital. Instead, his technicians are instructed to look for three things: the patient's feet should be pink, to demonstrate adequate blood pressure; there should be urine output, to indicate that the patient has not lost kidney function; and the surgical drain should be clear, to show no internal bleeding. Surgeons depend on large windows in the operating room to provide adequate light for operations.