Advanced technologies

From the date of opening of the Center 10 innovative technologies have been introduced including the implantation of artificial ventricle of heart, surgery using ROS Safe system, coronary artery bypass surgery using Cardioblate system, heart valve replacement surgery using Cardioblate radio frequency ablation system, heart transplantation, surgery using the method of transcatheter VSD closure involving ECMO, transcatheter LAA closure with the use of AMPLATZER Cardiac Plug occluder, balloon valvuloplasty of mitral stenosis, surgery including transcatheter aortic valve implantation, denervation of renal arteries, extracorporeal membrane oxygenation in nasty forms of cardiac and respiratory failure.

On November 7, 2011 the doctors of the Center implanted the first in Kazakhstan apparatus of auxiliary assisted circulation (Heart Made II). On December 13, 2011 the apparatus of the latest generation - Heart Ware Ventricle Assist Device (VAD) was implanted, thereby Kazakhstan joined the rank of 22 countries of the world conducting unique, high-tech open heart surgery.

On August 8, 2012 for the first time in our country transplantation of donor heart to the patient with chronic heart failure was conducted at the Centre.

Until 2014, 15 innovative medical technologies will be introduced at the Centre. The main areas of these technologies are: minimally invasive heart failure treatment options, hybrid surgery, and development of transplantation, non-surgical treatment of ischemic heart disease, development of neonatal cardiac surgery, and development of fetal cardiac surgery.

Innovative medical technologies introduced to the Center concerning the surgical and interventional treatment of cardiovascular system diseases are:

1. Implantation of assisted circulation apparatus. Over the last 6 years in the world VAD implantation was conducted for more than 13 thousand patients. 3% of patients after implantation of the apparatus have the opportunity of complete heart restoration. Life expectancy after implantation of VAD increases by an average up to 10 years. Upon that after the surgery functions of the whole organism are restored (liver, kidneys, lungs). Patients are not disabled persons and they return to an active life. In total, JSC “NCSC” has conducted 60 operations and among them as a “bridge” to transplantation – for 30 patients, as “final treatment” – for 19 patients, where at one patient a full recovery was planned with the ability to extract VAD.

2. Percutaenous transcatheter aortic valve implantation. Percutaenous transcatheter aortic valve implantation is one of the most frequently performed surgery at adults with associated diseases. To reduce the risks during aortic valve replacement a self-extracting endoprosthesis was developed, which is implanted using a minimally invasive percutaneous approach through the femoral artery. The operation is performed under general anesthesia. After the operation is completed the chest pain, faints and heavy breathing completely disappear at the patient. The experience of percutaneous aortic valve replacement grows rapidly. Indications for use of this technology are aortic valve damage. A total of 12 operations have been conducted.

3. Kidney denervation at resistant arterial hypertension. In the context of arterial hypertension surgical treatment options led to a decrease of arterial tension, however, they were accompanied with a heavy mortality before and after the operation. Moreover, the complications such as faints when changing position, dysfunction of intestinal canal and pelvic organs were observed. Catheter radio frequency ablation (hereinafter - RFA) of renal arteries is a medical technology of 3 class complexity. The method consists of introduction of a catheter through femoral approach in renal artery of the patient and conducting RFA under the control of angiography. Total time of radio frequency influence equals to 10 minutes. Duration of the procedure is 1.5 hours. Angiographic control is carried out in another month. Safety of the method was studied in a small clinical study conducted by scientists from the USA, Australia, Germany and Poland. A total of 18 operations have been conducted. .

4. Non-suture implantation of biological aortic valve. Self-expandable non-suture valve can be implanted using a minimally invasive surgical technique for replacing a diseased aortic valve of the patient or previously implanted prosthesis in patients with aortic defect. Upon that the need for traditional stitching is excluded. A total of 1 operation has been conducted.

5. Treatment of nasty forms of cardiac and respiratory failure using extracorporeal membrane oxygenation. The aim of the method is to reduce the number of complications and deaths at acute failure and cardiopulmonary decompensation resistant to the use of standard therapy. The strategy of the method is to use an apparatus that provides the function of breathing through extracorporeal membrane oxygenation (ECMO). Membrane oxygenator is connected to the patient. ECMO is a symptomatic therapy and does not eliminate the factor of disease development. The objective of ECMO is arresting of severe respiratory failure, acute heart failure and support of life during open-heart surgery in conjunction with artificial blood-circulation apparatus, as well as in organ transplantation (heart, lungs, complex of “heart/lungs”). A total of 9 operations have been conducted.

6. Balloon valvuloplasty of mitral gap stenosis. Application of balloon valvuloplasty of mitral stenosis is a new step in the treatment of cardiovascular diseases surgically. The basic principle of operation is to minimize traumatizing of tissues and organs - the discissions are replaced with centeses in the patient's body. Among the main advantages of this method there is a possibility of carrying out operations on a beating heart without the use of artificial circulation. This surgery approach is particularly relevant for older fragile patients for whom the use of artificial circulation is completely contraindicated (for example, due to pathology of kidneys or other organs). A total of 1 operation has been conducted.

7. Clipping of mitral gap. The basic principle of operation is to minimize traumatizing of tissues and organs - the discissions are with centeses in the patient's. When using this method mitraclip is set between the mitral valve leaflets, without heart disfunction. In this context the duration of hospital stay after surgery reduces, allowing quickly returning to normal life. Among the main advantages of this method there is a possibility of carrying out operations on a beating heart without the use of artificial circulation. .

8. Transcatheter LAA closure. Transcatheter LAA closure is used in the US for the past 7 years. The method includes administering of catheter with occluder to the patient's femoral artery, which isolates ear cavity from the atrium and prevents thrombosis. The entire procedure is carried out for 45 minutes under the control of transesophageal echocardiography and fluoroscopy. Time of hospital stay of the patient in the absence of complications is not more than 3 bed days. A total of 7 operations have been conducted.

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9. Cardiac surgery using a minimally invasive approach. The method is based on the use of videotorascopic installation with manipulators for surgical treatment of patients with ischemic heart disease, congenital and acquired heart diseases. This is a new step in the treatment of cardiovascular diseases surgically. A total of 16 operations have been conducted.

10. Coronary artery bypass surgery using RocSafe system. This method can significantly reduce the need of patients for transfusion of blood components during and after the operation up to 58% due to less mechanical influence on blood cells, reduction of the time of artificial ventilation and incidences of postoperative complications (atrial fibrillation and bleeding). In total 160 patients have been treated.

11. Coronary artery bypass surgery and heart valve replacement using Cardioblate intraoperative RFA system. It allows carrying out coronary artery bypass surgery and radio frequency ablation simultaneously. Level of efficiency of treatment of patients with circulatory diseases using this technology is 95%. It is successfully used in the world over the past few years. When using this technology the number of thromboembolic disorders against atrial fibrillation reduces. In total 160 patients have been treated.

12. Heart Transplantation. Surgery for replacing heart of the patient (recipient) for donor heart. It is necessary in case of severe heart diseases, where other operations are impossible or extremely risky, and life expectancy without heart transplantation is low. On August 8, 2012 on the basis of JSC “National Research Cardiac Surgery Center” for the first time in Kazakhstan transplantation operation was conducted. The operation was conducted by the leading cardiac surgeon of Kazakhstan Yuri Pya with the involvement of cardiac surgeon from the Czech Republic, Jan Pirk.