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The patient-controlled treatment prescribed for clogged arteries includes regular checkups, a low-fat diet, exercise, relaxation, and no smoking. Success depends on the patients’ willingness and determination to trade in their harmful old habits for healthful new ones that will enable them to enjoy longer lives. The heart transplant – the most dramatic surgery of all-probably pays off best in the number of years of life gained.A transplant replaces the failed heart that, weakened by heart attack or infection, produces a blood flow that has declined to a trickle. While anywhere from 11,000 to 20,000 patients are eligible for heart transplants, on average, only about 2,000 hearts are available yearly in the United States. It becomes a waiting game.To maximize the survival chances of those who wait for a heart transplant, these choices are offered:• The use of new mechanical hearts to sustain the patient waiting for a donor heart. These machines, intended for temporary use, are working increasingly well and may prove equal to or better than transplants, which have a 5-year survival rate of 50 percent.• The use of animal hearts with medications to prevent rejection. This technique has been tried four times, but the recipients rejected the organs and died.• Heart-strengthening medications to help transplant candidates’ survive while on the waiting list for a new heartBut a crisis is emerging.”If we continue to list so many [non-critical] patients for transplantation as we now do,” says Dr. Stevenson, “in 4 years’ time we will reach a point where none of the unhospitalized patients will have a chance for a transplant. People have to wait too long. They deteriorate, making their chance for survival poor.”One heart transplant recipient, Brenda Butler Hamiett, then 48, of Jamaica Plain, Massachusetts, says, “Before my transplant, I was too tired to blink.” Now, Mrs. Hamiett reports, she happily exercises, watches her diet, and keeps track of her blood pressure.Dr. Adrian Kantrowitz, professor of surgery at Wayne State University College of Medicine in Detroit, was the first to implant a human heart in the United States, at Maimonides Hospital in Brooklyn, New York, 3 days after the world’s first human heart transplant by Dr. Barnard in 1967. Dr. Kantrowitz cites good results from heart surgeries for infants, too.”We repair congenital defects extremely well,” says Dr. Kantrowitz, “and we successfully operate on infants born with impaired connections between the heart arteries.” He places the mortality rate for that surgery at less than a tenth of 1 percent. For valve replacement surgery, when using plastic or stainless-steel devices or valves taken from pigs, the rate is 2 percent, he says.The final verdict on the effectiveness of these procedures is not yet in, but all heart disease must be treated-by you as well as your doctor.*16/266/5*