The revolutionary endovascular technologies allow to save people from death, and in a couple of days after surgery, patients can go to work
- Bagrat Alekyan convinced that specialized centers must work 24 hours a day, 7 days a week
In fifteen minutes, Academy of Medical Sciences, Head of NTSSSH them. Bakuleva, chief inspector of the Ministry of Health for endovascular diagnosis and treatment Bagrat Alekyan operated on two patients. Semidesyatishestiletny woman put a stent, preventing third heart attack; sorokapyatiletney patched a hole in the wall between the atria. Both were conscious, their eyes wandered over the faces of doctors and nurses. On the monitors watched by a dozen doctors-in-training, was seen as the vessel enters a catheter inserted into the femoral artery. In one case out of it floated like a stent, a tiny at first, then expanding to the diameter of the vessel, while the second — a special "patch" that both sides are sealed tight hole in the heart. "Well, that's all," — said Bagrat Alekyan, leaving the second operating after a ten staying. And it was amazing. No blood, no gaping chest, no fear on the faces of patients. All very fast and high-tech, almost like a conveyor.
— Known that about half Death in Russia have on sharp heartvascular disease. A you as-that said that theoretically 80 Percentage cases these Death one can was to avoid. Why same people die?
— Indeed, 53 percent of patients die from diseases of the heart and blood vessels. Among the diseases of the heart is very common acute myocardial infarction or acute coronary syndrome, which rapidly leads to death. 20-25 percent of patients die, the remaining 75-80 percent of the disabled. Note that it is often very young people — forty to fifty years. The state must spend a lot of money due to the fact that these people are unable to work. But thanks to new methods of endovascular surgery can treat acute myocardial infarction very quickly. Our main task — to create a system to the patient, an emergency room physician who has diagnosed "acute myocardial infarction", delivered as quickly as possible to the desired clinic, where there are special operating rooms, special tools and experts. After all, what is a heart attack? It occurs due to the fact that the container overlaps the bloodstream. If the patient quickly deliver a specialized operating room, where he will deliver a stent, thereby expanding the blood vessels, which can prevent a heart attack. Mortality in this group is only four to five percent. Compare this to 25 percent, which were discussed above.
— True whether, that only about five percent patients which put diagnosis "sharp myocardial " deliver in such special centers?
— Unfortunately, it is. The vast majority of patients received a conventional cardiology departments who can not do such operations.
— But why?
— Imagine, for lack of a document that would clearly say that with such a diagnosis the patient should not take the usual coronary care unit, and in a special operating.
— A really doctor Emergency help it not knows?
— He knows, but he can not take such a patient. This question is not regulated. In Moscow, there are forty of these specialized centers. Of these, almost half — Federal. There is a problem between the federal and local organizations, because they have different budgets.
— This in head not fit, What same people die because that no appropriate interdepartmental Paper?
— We seek to such document appeared. Under the guidance of Academician Yevgeny Chazova and Leo Bokeria we spent two all-Russian conference prepared a national program at the Academy of Medical Sciences, where he raised the issue. We hope that it will finally be resolved.
— These magpie centers enough would Moscow that help everyone patients?
— Above the roof. In our center, seven operating rooms. We could have a day to take ten to fifteen patients with acute myocardial in Moscow. A similar situation in the Russian Cardiology Research and Production Complex Ministry of Health. To us in the federal government brought in patients from all over the country, and Moscow with acute heart attacks — almost never. Many centers are open from nine to three days, and have to work twenty-four hours a day, seven days a week.
— Before bitter joked that heart attack diagnosed already slightly whether not after death patient. There is whether now Technology, allowing anticipate heart attack or Stroke?
— Technology is. But they still want to tak
e advantage of. Unfortunately, the level of our patients is that there are only humbly surprised. We treat heart attacks, and doctors say colleagues, well as you descended to this, since you all know something … This should be constantly talking. Remember how ill at the time, Boris Yeltsin, and the country learned of coronary bypass surgery. There are simple technology — electrocardiography, echocardiography, stress tests, which are usually identified patients at risk. And then we send them on such diagnostics as coronary angiography, where doctors are already seeing an accurate picture of the blood vessels. And then to decide: either stenting or bypass surgery or conservative treatment.
…In the study looks nurse: "Bagrat Gegamovich, you wait in a third operating." Alekyan asks, "Do you want to see how such operations are done?" We don robes and hurry him. After a couple of minutes Alekyan already leaning over the patient, and we, along with doctors, interns are seeing through the glass and look at the monitors of preoperative. Bagrat Gegamovich out five minutes later and quickly scrolls through the images on the screen: "Look: inserted through the femoral artery catheter gets to the right place, here the vessel is narrowed by 90 percent. In this place of catheter and the stent is released. Look at how he immediately straightens and widens the vessel to a normal state. "
- No disclosed breastbone — through the femoral artery catheter, from which pops stent
Again, there is a head in the doorway of a nurse, "Bagrat Gegamovich Please come back in the sixth …"
After another five minutes of manipulation in the operating Alekyan shows the main point of the monitor. "The woman congenital — a defect inside the walls of the heart, just a hole. We are launching a special balloon catheter, which will measure its diameter, so that we were able to pick up occluder device for sealing such holes, the right size. " We see how the occluder, like jumping out of the catheter becomes two flat "donut" that patch a hole on both sides.
After the patient to the operating room will deliver three days of the child. It has a so-called critical pulmonary stenosis — vessels narrowed so that practically no blood enters the lungs. "Imagine that not so long ago did newborn surgery, opening the sternum. And it's very often resulted in death. Now we can in many cases save the children, using endovascular little traumatic. "
We go back to the office.
— You held in each operating about on five-ten minutes. This it seems on job in what-some workshop …
— In fact, like conveyor. You have seen two operations. And the day they happen to fifteen, along with the diagnosis goes up to forty patients.
— If compare with America or Europe as at us The situation are you?
— On the one million people in Europe are approximately two thousand stenting operations. Last year we did 541. A 2000 — total 17 such operations. No country in the world has such rates of growth, both in Russia.
— A themselves centers in country enough?
— Today, in a country of nearly 200 centers. And in which 330 operational. In the past year, through these centers was 330,000 patients, that is, each operating — one thousand patients, it is very small.
— What is the same need?
— We need to increase that figure to five times — up to half a million. If we do more than a thousand operations in each operating, and three or four thousand, we will solve the problem completely.
- On the whole operation — half an hour to install the stent hands of a master — five minutes
— Grabs whether experts?
— In 2004 there were only 258 people. Now, under a thousand. Each year growth by acquiring more than 100 people. We should have a lot of energy in general to enter a profession — endovascular diagnosis and treatment. We have started educational programs, the department is open. To operating working around the clock, of course, still need specialists, but the issue is solved.
— And all same the word "quota " always causes bewilderment. Centers is, experts is, and Quota often not allow save people …
— What are you? Quota — good word. Previously, no nothing. Who allocates significant funds: one for each patient has at 203,000 rubles. It is now four or five years. That money helps us a lot every year to increase the number of operated.
— But need-that more?
— Hold on, always need more. It's high-tech, expensive equipment — for each operating about half a million dollars. One occluder is worth about five thousand dollars. And with virtually no problems, the patient was in the quota.
— Endovascular surgery enough young. Could would you say what Technology there relatively recently and what can appear in near the future?
— In 1966, the U.S. Surgeon Rashkind made the first step a child with a birth defect. Then these oper
ations are mainly made for children, but they were still quite exclusive. But the mass began with stenting around the late 1970s. Now the world make 3.5 million stenting procedures per year. Third operate in the USA. We did it last year 75,000 coronary artery stenting. But at the same time since 2003, we have grown to twenty times.
Stenting began with balloon dilatation. However, very quickly it became clear that half of the patients returned to the operating table. A cholesterol plaque, which was pressed cylinder, extending the vessel began to press again and narrowed the space for the passage of blood. Then, instead of the stent cylinder invented thin metal grid. And I think that this is the final breakthrough solution. But no, again, every third patient has to come back for a second surgery. Plaques grow through the mesh stent. And then in 2002, a special drug-coated stent, which stops the growth of these plaques and their germination. The current generation of stents returns only five to seven percent of patients. This is major progress. Who came up with a biodegradable stent that keeps the vessel two years, and then resolves. But while the world is studying the results of such practices.
- "You see, we have introduced the cylinder to measure the diameter of the hole in the cardiac septum"
— Stenting really one can count Revolution because it allows do nontraumatic operations not only on vessels heart?
— Yes, stents are used to expand the vessels of the legs or in the carotid arteries — to prevent strokes. But the most fantastic modern means I believe the aortic valve, which came up with my friend Alan Kribi surgeon from France. Aortic valve replacement in the elderly — a very common operation. But not all seniors can move open heart surgery. So for them the aortic valve, which is inserted through a catheter — a winning ticket. Americans got permission to use it in November last year and have already put 25,000 of these valves. We in Russia have put 140. This is just a question of money. Innovative valve is 30-40 thousand dollars.
— What more technological opening waiting endovascular surgery?
— There was another very interesting area — the treatment of hypertension. Today, modern medicine good help from this disease. But there are patients who drink three different drug, and those they do not help. For this category of patients are now using a new technology: a special catheter is passed into the renal artery, through them, under the influence of radio destroyed the nerves and the pressure is reduced by 30 mm Hg. While the application of this method shows very high efficiency. Technology is fast improving. Many companies are working on tools that allow us not only to put, for example, stents and valves, but also to remove them using a catheter, if they were not so successfully implanted.
— As far as new Technology facilitate job Surgeons?
— Of course, easier, though, if you know how to do it well. The main thing is that they facilitate the process for patients. The doctor may do surgery on the heart and tell the patient an anecdote. Two days later, he gets up and goes almost healthy. Is not that fantastic?
- Growth dynamics of endovascular diagnostic and therapeutic interventions in the Russian Federation