Television Review

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The Independent Culture
I have a feeling that Professor Gianni Angelini should brace himself for some late-night telephone calls from Kensington Palace. Quite apart from the fact that he looks like a well-weathered Armani model (diffusion range), he can also get you tickets for the hottest cardiac theatre in town. "Brave Hearts", QED (BBC1), explained how Dr Angelini is currently attempting to introduce to Europe a radical new heart operation, one he described himself as "the best thing that has happened in cardiac surgery in the last 30 years".

Grand claims like that are meat and drink for medical documentaries, for whom the miracle breakthrough is the blue-chip stock, a narrative of new hope which has already established its own genre conventions. You begin, naturally, with apparent hopelessness - a patient in acute distress, their life reduced to the merest sliver of vitality. In this case, that was provided by images of John Coldrick, a man suffering from a heart working at a fraction of its normal capacity, and by Peter Nixon, talking you through his painful ascent of a flight of stairs as if he was Chris Bonington describing the last 50 feet up Everest. "I'd give heaven and earth for something to be done," said Coldrick's wife, "But... let's hope for a miracle."

Cut to Professor Angelini watching a remarkable video film of a virtually heretical operation in which a large slice of the left ventricle is removed and the gap sewn up, thus reducing the volume of the heart. This is not conventional procedure in cardiac surgery, as you were repeatedly reminded, and it had, unsurprisingly, been pioneered in a place very remote from peer group pressure and the necessary caution of ethical committees. In the Brazilian jungle, Dr Randas Batista - part-time rancher and part-time surgeon - had developed the technique after noting that the ratio between the volume of the heart and the thickness of its muscle obeyed a strict ratio in healthy animals. In enlarged hearts, the ratio changes, diminishing the efficiency of the body's vital pump. Professor Angelini set out on a pilgrimage (the journey to expand knowledge is another genre convention) to witness the miracle.

Back home, the final stage of the narrative was in place - the moment of truth when the new technique is tested in action. There was a paradox here; in Brazil the operation had been performed on patients of all ages, including a 20-year-old, apparently restoring him from geriatric invalidity to youthful vigour. In this country, though, the ethical committee insisted that such a radical procedure must be tested on those without any other hope, not the ideal patients for such delicate work. As a result, the outcome wasn't as heroically clear-cut as it might have been. Two patients died shortly after surgery and John Coldrick, a touch-and-go success story, succumbed three months later to an unrelated illness. "Brave Hearts", to its credit, did not fudge these details - letting you see that mortality is intimately a part of all surgical interventions, not just a crude alternative to them. What was clear was that this extraordinary piece of biological plumbing offers a real potential to transform the lives of people who have been placed, rather literally, out of circulation.

But "Brave Hearts" was not just about the wonderful technology of cardiac muscle (one extraordinary scene showed a bloody fillet of heart still beating on the surgeon's palm). It was also about "heart" in its broader senses, as an emotional shorthand for tenderness and courage. In his Brazilian hospital, Dr Batista stroked the cheek of a distressed patient, soothing her fears with a gesture of untechnical comfort. Professor Angelini clearly shared that emotional commitment to his patients, but his own investment was larger still. Where Dr Batista, an unknown country doctor, stood to gain a reputation, Professor Angelini, a celebrated cardiac surgeon, might easily have lost his. On this evidence at least (and he is currently administering a much larger trial of the method), he can only have enhanced it.

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