Prof. Danov: At Heart and Brain, we are analysing the benefits of innovative cardiac surgery for our patients

The aim of the project is analysing the current clinical management at both cardio-surgery clinics (MBAL “Hearth and Brain” – Pleven and MBAL “Heart and Brain” – Burgas), establishing an algorithm and determining measures for optimization of the treatment process with aim to achieving better results in overall patient treatment, in addition to balanced management of financial and other resources regarding patients with isolated aortic defect subject to surgery.

The team analyses the clinical practice and assess the clinical and financial efficacy of the two methods: minimal (upper partial sternotomy) and conventional (full) sternotomy in patients with isolated aortic valve defect. Additionally, the clinics are determined to incorporate algorithms for optimisation of patient clinical management in accordance with existing clinical paths, cardio-surgery standards and good clinical practice.

“Our clinical expertise indicates that the minimally invasive approach is a routine cardio-surgery technique for aortic valve prosthesis as well as for cases in plastic surgery or prosthesis of the aorta ascendens. The use of standard methods in combination with extracorporeal circulation (cannulas and surgery instrumentation) makes the method accessible without the need of further investments. Minimising invasive traumas is beneficial to quick recovery of patients, doesn’t bring any additional risks and decreases the probability of significant complexities such as sternal instability and mediastinitis” – the team states.

Elsewhere, the same method is being applied in the cardio-surgery of MBAL “St. Anna”-Sofia, as well as abroad.

Expenses are accounted at a patient and department basis, including administrative and economic expenses and economic effectiveness is assessed by the team. Consequently, it results that the minimally invasive approach minimises traumas, loss of blood and pain, whilst shortening hospitalisation and reanimation times.

 

Prof. Dr. Vladimir Danov: Minimally Invasive Methods are Milder than Conventional Surgeries

Which are the most innovative courses of your specialıty?

The medical teams at the cardio-surgeries and invasive cardiology departments of MBAL “Heart and Brain” in Pleven and Burgas are paramount to the Bulgarian Cardiac Institute. These same teams managed to successfully incorporate the most innovative global technologies in treatment of patients with cardiovascular diseases on a day-to-day basis. The staff is specialized in carrying out mildly invasive surgeries, which can be categorised in three groups.

The first one covers invasive cardio-surgery methods with minimal incision and endoscopic video-assisted technology for changing or reconstruction of valves, reconstruction of inborn cardiac defects or coronary bypass surgeries. The second group includes surgeries of a beating heart without the assistance of a heart-lung devices i.e. OPCAB – off-pump coronary artery bypass. The third group are the invasive interventions carried out by the “Heart Team” – a multidisciplinary team, composed of cardio-surgeons, invasive and non-invasive cardiologists, anaesthesiologist specialises in cardio-surgery, and medical imaging specialists. They are engaged with minimally invasive procedures (transcatheter aortic valve implantations – TAVI, thoracic endovascular aortic repair – TEVAR and endovascular aneurysm repair – EVAR).

These type of interventions are significantly milder than conventional surgical methods and provide optimised patient recovery.

Do you apply these in Bulgaria and are they reimbursed by the National Health Insurance Fund (NHIF)?

Minimally invasive endovascular procedures are already routine practice in both the cardio-surgery and cardiology departments of MBAL “Heat and Brain” in Pleven and Burgas. All seven hospitals held by the Bulgarian Cardiac Institute cooperate with the NHIF. Cardiac rings and valves, used in cardio-surgeries are covered by the insurance fund. However, endovascular aortic stents are only partially reimbursed. The NHIF reimburses up to 5000 BGN leaving a substantial amount for patient co-payment. The amount can vary based on the prices set by different importers and quantity of medical implants necessary for the patient

What are the effects of using minimally invasive approach in valve prosthesis and reconstruction?

With improving longevity, increase in polymorbid patients is observed, which brings about the need of developing less invasive and milder techniques to improve post-surgery recovery, ease pain and minimise mechanical ventilation, post-surgery traumas and early active rehabilitation. Furthermore, financial expenses related to the accuracy of applied surgical techniques. The project focus is on minimal upper aortic stenosis and its routinisation in clinical cardio-surgery practice. There is no need to fully open the sternum – a third of the upper section is enough to change the defected aortic valve. It is paramount that the cardio-surgeon in charge of the procedure is highly experienced in surgeries based on the conventional method.

This approach was jointly introduced in Bulgaria by Dr. Vladimir Kornovski (head of the the cardio-surgery department in MBAL “Heart and Brain” – Burgas) and Dr. Peter Uzov (head of the cardio-surgery department in MBAL “Heat and Brain” – Pleven). Up to this point over 300 patients are treated and showing excellent results.

The method minimises traumas and the natural defensive “immunological” response, which results in beneficial post-surgical recovery; minimal blood loss; minimal reanimation period; reduced hospitalisation period; easing of pain and lack of need to take additional medications. The incision is around 7cm – relatively cosmetic compared to 22cm in the case of the standard surgery. Least, but not last – stability of the sternum is preserved.

 

What is the future of cardiac surgery?

In the perfect symbiosis between the various specialists working in the field of treatment of cardiovascular diseases, i.e. “HEART TEAM” – a cardiac team consisting of cardiac surgeons, non-invasive and invasive cardiologists, anesthetists and imaging specialists to perform and develop together the methods of minimally invasive interventions and cardiac surgeries.

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Prof. Dr. Vladimir Danov, MD is Executive Director of the Bulgarian Cardiac Institute; Medical Director and Head of Cardiac Surgery Clinics at the Heart and Brain Hospital chain in Pleven and Burgas. German citizen of Bulgarian origin. From 1991 to 2005 he worked at leading cardiac surgery centers in Germany, and for the last 5 years he has been the head of the department (Oberarzt) at the Cardiac Surgery Clinic at the University Hospital in Augsburg – Germany. From 2005 to 2017, Professor Danov established two cardiac surgery clinics at St. Marina Hospital in Varna (2005) and St. Anna Hospital in Sofia (2008). In 2000 he defended his Doctoral thesis at the Ludwig Maximilian Univesität – München. He is Professor of Cardiovascular Surgery at the Medical University – Pleven and the University of Ruse “Angel Kanchev”. He is the author of 8 textbooks, 3 monographs, over 92 Bulgarian and international scientific articles and more. He was awarded with the title Doctor Honoris Causa of the Technical University in Varna.

The full article published in Capital Health is available here in Bulgarian.