Cardiac surgery

Cardiothoracic surgery in Kazan: past, current state and future perspectives…
R. Dzhordzhikiya, G. Kharitonov, A. Sadykov, I. Vagizov, M.Mukharyamov, N. Gilfanov, I. Abdulyanov

 

It is the patients who die in the struggle that surgeons do.
But at that moment when the heart stops
and life  is slipping through your fingers like water
how many times did I want to give everything to keep it!
I would give the half of my life. All my life. But no one would take it.

Nikolai Amosov
«Thoughts and the Heart»

 

 

 

 

 

 

 

 

In 1963  on the initiative of N. Medvedev 12 beds for patients with heart and vascular diseases were allocated in the surgical department of the 6th city hospital. 

The first and successful  operation in this department was performed on April 15, 1963. The patient, 26 years old, with rheumatic mitral stenosis was operated on by Professor N. Medvedev.

 

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N. Medvedev 6th City Clinical  Hospital
(Former Kazan Higher Party School situated in the building of Ecclesiastical Academy)

               

The first cardiac master class procedures (closed mitral commissurotomy) was performed by the member of the Academy of Medical Sciences A. Vishnevsky in the third city hospital in 1958. Sooner, the head of the department of hospital surgery number 2 of Kazan State Medical Institute, Professor N. Medvedev was sent for special training in cardiovascular surgery at Institute of Surgery named after A. Vishnevsky (Moscow).

 In 1963 , the specified department and the surgical services were transferred from the 3rd city hospital to the 6th city clinical hospital in Kazan.

Within the first year 44 operations were performed, 21 of them were closed mitral commissurotomies with mortality percentage of 24. Surgeons mainly used digital commissurotomy. Dubost’s dilator was used only in 2 cases, both patients having died from traumatic mitral insufficiency. It is important to note that in three patients the extending of mitral orifices was failed due to excessive calcification (two patients died). One more patient died of cerebrovascular thromboembolism. Ligation of patent ductus arteriosus, Blalock-Taussig anastomosis for Tetralogy of Fallot and in 1 case - Vishnevsky-Donetsky shunt using lyophilized vascular graft were performed for congenital heart disease. Also 12 phlebectomies of varicose veins, 1 iliafemoral bypass were carried out.

On April, 21, 1964, atrial septal defect in 5-year old boy was successfully closed under moderate hypothermia conditions. 

It should be pointed out that instrumental diagnosis was far from perfect those days. Health professionals had just started developing hypothermic methods of body protection and anesthetic management and gaining experience in these fields. Cardiopulmonary bypass (machines) were primitive. Oxygenators, surgical threads and monitors were not perfect. 

Nevertheless and regardless of time, healthcare professionals of the clinic practiced operating techniques, acquired hands-on proficiency in hypothermal conditions, cardiopulmonary bypass, as well as underwent training courses, nursed very ill patients selflessly. 

In 1967, in 5-year old boy the atrial septal defect closure operation with cardiopulmonary bypass was successfully performed. 

 

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(First operations with cardiopulmonary bypass)

 

In 1970, a specialized cardiac surgery department with 30 beds was organized. Operations for patent ductus arteriosus, atrial septal defect, ventricular septal defect, partial anomalous pulmonary venous connection, pulmonary artery stenosis, trilogy of Fallot, coarctation of the aorta, palliative surgery for Tetralogy of Fallot were performed there. Closed heart surgeries in acquired heart diseases and pacemakers implantations in heart block were also carried out.

In 1983, one of Prof. N. Medvedev’s most talented students, concurrently his son, Assistant Professor V. Medvedev became the Head of hospital surgery department No2 and the head of the clinic. 

 

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V.Medvedev

 

Methods of hypothermic protection of body – such as moderate and profound hypothermia - were implemented under his guidance and became widely used for the correction of congenital heart disease. Simultaneously, surgeons began to perform operations with heart and lung machine and hypothermal myocardial protection on patients with complex congenital heart diseases as well as with acquired heart defects.

              

In 1980, healthcare specialists of Cardiovascular Surgery Department took up using cardiopulmonary bypass equipment Pemco (USA). Multidose foam oxygenators were used for oxygenation. This allowed extending the range of surgical interventions but high mortality accompanied long-lasting procedures. In 1993 CPB Gambro (Sweden) with disposable membrane oxygenators was bought. The use of such equipment contributed to significant improvement in the outcomes of cardiac surgery.

In 1992, the Department was transformed into Kazan Center of Cardiovascular Surgery with 75 beds, since 1995 having been named after Professor N. Medvedev. Department of congenital heart diseases (25 beds), department of acquired heart diseases, coronary heart disease, heart rhythm disorder and diseases of great vessels (50 beds), cardiac catheterization laboratory, artificial circulation laboratory were organized.

In 1993, coronary artery bypass grafting operation was performed in Kazan for the first time.

In 1997, in the center ascending aortic aneurysm and the aortic valve replacement with reimplantation of coronary ostia - the so-called Bentall procedure, coronary bypass surgery on a beating heart, were performed in the center for the first time.

The definitive remodeling of Fallot’s tetralogy, heart valves replacement, removing the heart myxomas, etc have become ordinary interventions in N.Medvedev’s Kazan Center of Cardiovascular Surgery by the end of the 20th century. 

In 1995, with the support of Rodion Nakhapetov’s charity fund, the team of cardiac surgeons and anesthesiologists from Stanford University, USA, under Professor Bruce Reitz guidance arrived at Kazan Center of Cardiovascular Surgery to perform operations for congenital heart defects in children. This visit inspired the Kazan team to develop the innovative technologies in cardiac surgery.

Medical specialists of the center Anwar Sadykov and Ildar Vagizov underwent a training course at Stanford University - one of the world's leading cardiac clinics in the world, in 1996, and later in 2001 visited European School for Cardio-Thoracic Surgery in Bergamo, Italy. 

In 1994, graduate of the Kazan school of cardiac surgery, Associate Professor Leonid Mirolyubov left the 6th hospital for Children’s All-Republic Clinical Hospital, where he became the head of the cardiac surgery department for congenital heart defects. Today the Department performs a wide range of cardiac surgeries, including in infants with severe abnormalities of the heart and major blood vessels, and is considered to be one of the country's leading cardiosurgical departments in our country. 

 

Since 2000, Associate Professor Roin Kondratyevich Dzhordzhikiya has headed the Department of Surgical Diseases № 2 in Kazan state medical university and Kazan Center of Cardiovascular Surgery named after N. Medvedev.

In 2000, 654 operations of heart and blood vessels were performed in the clinic: 174 congenital heart disease surgeries, 150 surgeries for acquired heart disease and congenital heart defects, 112 surgical interventions for arrhythmia, 218 vascular procedures. 122 open-heart surgeries under moderate hypothermia, 122 operations with cardiopulmonary bypass were performed. Postoperative mortality was  3%.

Since 2000, minimally invasive surgical interventions for congenital and acquired heart diseases has been implemented, methods for selecting surgical approaches has been developed.

This work resulted in R.K. Dzhordzhikiya’s PhD thesis on minimally invasive cardiac surgery, which is more relevant than ever nowadays and, undoubtedly, so it will be in the future when the requirements for less injuries and cosmetic result of operations continues to rise.

In 2006, largely full staff of the center moved to ICDC. Since 2004 General Director of ICDC has been the heart surgeon, Rustem Khayrullin, the student of Rinat Akchurin, member of the Academy of Sciences, МD, PhD. 

 

Two Cardiac Surgery Departments were organized, having 40 beds in each. The Cardiac Surgery Department No1 focuses on surgical management of coronary heart disease and its complications; the Cardiac Surgery Department No2 does on surgical management of heart valve pathology, congenital defects in adults, pathology of thoracic aorta, heart tumors, pulmonary embolism etc. 

Modern material and technical resources, equipment supplies in accordance with the latest requirements, one of the best equipped surgery units of Russia in ICDC, coupled with trained and experienced team of cardiac surgeons and related specialties opened the door to large qualitative and quantitative leap in providing cardiosurgical care to the population of the Republic of Tatarstan and neighboring regions.