‘Heart and Brain’ is the leader in minimally invasive heart surgery

Patient aged 41: “The cardiac surgeons restarted my life completely, I’m now living fully”

Assoc. Prof. Kornovski, according to the National Health Insurance Fund, Heart and Brain Burgas is the leader in cardiac surgery and the first choice of patients in the country for 2022. Tell us a little more about the experience of the clinic.

Assoc. Prof. Vladimir Kornovski, MD: There is undoubtedly no more impartial and accurate testimonial to the professionalism of the teams of the modern hospital complexes in Burgas and Pleven. As the head of the Cardiac Surgery Clinic, I am extremely proud of the results achieved and the trust gained. Since the launch of ‘Heart and Brain’ the standard in valve pathology has been the minimally invasive surgical approach. Over 90% of our valve operations are performed in this way. Standard access to the mitral and tricuspid valves is endoscopic through a 3-4 cm skin incision. Recently, the clinic has also been performing total endoscopic aortic valve replacement through a 4 cm incision – just enough to pass the implant. Currently 92% of mitral valves are also reconstructed minimally invasively, which is in line with European statistics. It is important to note that in mitral valve disease, our primary goal is to preserve the patient’s own valve, i.e. to perform a valve reconstruction or repair, this is the “gold standard” in global medical practice. But it should also be known that not every valve can be reconstructed, especially when valve changes cause stenosis. In our clinic, for patients with degenerative mitral insufficiency (mitral valve prolapse), we use a technique with so-called neo-chords (special sutures) to restore normal valve closure without the need to cut any part of the valve.

I greatly appreciate the knowledge and experience of our team – Dr. Peter Uzov is a highly specialized heart surgeon who operates entirely with a minimally invasive approach and has mastered the techniques to perfection. We approach all patients with left coronary artery disease with a minimally invasive approach (MIDCAB), performing the surgery on a beating heart without cutting the sternum. Also, this method is part of the so-called hybrid revascularization, in which the left internal carotid artery is used for bypass to the anterior descending artery, and a stent is placed in the remaining coronary arteries by an invasive cardiologist. This requires excellent collaboration with the invasive cardiologists, which is routine in our practice and we achieve excellent results. Last but not least, I would like to share that my entire team at the clinic is training and upgrading their knowledge in minimally invasive cardiac surgery on a daily basis. At ‘Heart and Brain’ Burgas we are creating a school for our future followers to learn from.

Dr. Uzov, how does minimally invasive surgery work?

Dr. Peter Uzov: In all minimally invasive procedures, the heart is accessed through a small incision on the side of the chest or in the upper part of the sternum. During part of the surgery, the function of the heart is taken over by a heart-lung machine that maintains the normal functioning of all the organs in the body. Endoscopic (minimally invasive) surgery uses a thin, high-resolution video camera that is inserted through a small incision in the chest. With this camera, every part of the heart can be visualized, even many times better than with the open approach. The surgeon reconstructs the valve using endoscopic instruments, the operation is performed through a working channel of about 4 cm. After the intervention, rehabilitation begins as early as possible with the patient standing up a few hours after the operation. After the stay in intensive care, the patient spends several days in the cardiac surgery unit, where his condition is constantly monitored by telemonitoring. Before discharge, patients are completely independent and do not need specialized care. A week after leaving the hospital they have no restrictions and can return to their usual activities, work and sports. We return fulfilled people to their families.

What are the benefits of minimally invasive heart surgery?

Dr. Peter Uzov: The minimally invasive approach is appropriate for any patient with valvular disease; there are very few limitations that we exclude when we admit the patient. The valve surgery is the same as the patient receives in open surgery. The advantages are: no pain, significantly less blood loss, lower risk of surgical wound infection, shorter hospital stay, quick recovery and return to normal activities and last but not least, a better cosmetic result.

Dr. Uzov, we have been contacted by your patient Miroslava Mikhailova, who is only 41 years old and was operated by you with a minimally invasive technique. In her words – you have saved her from disability and “restarted her life completely”. She described you as an outstanding doctor and expressed her immense gratitude to the clinic and to you personally. “If I didn’t know I was being operated on, I wouldn’t have known in any way. I am living fully again and feel wonderful,” she said. Please tell us more about her case.

Dr. Peter Uzov: Miroslava came to the clinic with Barlow’s disease, a heart condition that occurs in young people. It is a prolapse of all segments of the mitral valve and high-grade insufficiency, which requires complex valve reconstruction. In Miroslava’s case, the complex valve reconstruction was performed completely endoscopically. The intervention went smoothly and at the very first follow-up she felt excellent. I am happy to hear her high evaluation.

I recommend that anyone who has complaints of palpitations or shortness of breath have their heart checked for structural disease by echocardiographic examination. My observations are that Bulgarians are a patient people and tend to neglect their cardiac discomfort for years. It is important to know that if heart surgery is done in time, the life of those operated on is no different from that of healthy people. After endoscopic heart surgery is performed, patients can play sports again within just a week after being discharged from the hospital.

Assoc. Prof. Dr. Vladimir Kornovski, MD: Since we are talking about Miroslava, who is a very young woman, I would like to give an example of a case of a significantly older patient that we operated on with Dr. Uzov. He is 84 years old and he underwent a total endoscopic aortic valve replacement. The patient was contraindicated for TAVI and was offered endoscopic minimally invasive surgery. Recovery was similar to the TAVI intervention. Surgery was performed on a 4 cm access port. The patient was ambulated 4 hours postoperatively with no restriction in movement. He is currently discharged and enjoying a normal lifestyle.

Assoc. Prof. Kornovski, do patients need to pay extra for minimally invasive surgery?

At Heart and Brain, all cardiac operations, including minimally invasive ones, are fully covered by the NHIF and I stress that patients pay absolutely nothing extra.