In patients with severe aortic valve disease, aortic stenosis (narrowing), the only solution is the aortic valve replacement. The replacement may be done with a cardiac surgery or the TAVI procedure.
The classical surgery as a solution for aortic valve replacement involves a number of risks, as well as a slower recovery. Yet, the TAVI method excludes the surgery, i. e. opening the patient’s chest.
What is the TAVI procedure and whom is it intended?
The TAVI, or a Transcatheter Aortic Valve Implantation, is a procedure for treatment of a severe aortic stenosis without a surgery. This means a less invasive approach, implantation of an artificial valve without incision in the sternum bone, using a sophisticated catheterization system, through the groin arteries.
Even though the TAVI is still considered a relatively new procedure, it is widely used and approved in the United States and in the European Union for the treatment of certain high-risk patients with a severe aortic stenosis.
What are the advantages?
The newest medical discoveries indicate that the high-risk patients with a severe aortic stenosis are best treated with a TAVI procedure, which is safer as an intervention compared to the conventional aortic valve disease surgery. The TAVI procedure is a treatment of choice for these patients for several reasons:
less trauma during this intervention,
greater patient comfort,
fewer peri-procedural and post-procedural complications and outcome, contrary to the classical surgery
treatment of high-risk patients with severe aortic stenosis.
How is the procedure performed?
After a correct echo graphic assessment and angiographic heart check-up has been completed, also to the aorta, to the peripheral blood vessels, as well as a selective coronary angiography, the TAVI procedure is started, i. e. the placing of a transcatheter aortic through a small incision in the groin area.
The placement of the aortic valve through a catheter (TAVI) is performed in an angiography room. The patient is under general anesthesia. A temporary pacemaker is placed in the jugular vein, to control the pulse rate during the application of the aortic biological valve. Through the groin artery (left or right) which is surgically opened, plastic tubes are placed through which the biological aortic valve is introduced until the heart and it is fixed in the place of the old valve. After the biological valve is set, it immediately starts its function. The placement is made during a continuous X-ray supervision and frequent aortographies (before, during and after the implantation) and a pacemaker set on a rate of 180 / min. After the setting of a new valve, follows the surgical closure of the groin artery and movement of the patient in the intensive care ward. After the intervention, patients usually stay in the hospital under observation for only 24 hours, i. e. until the next day, and then they are released home with a prescribed therapy. Of course, in certain procedures where complications have emerged, the patient might need surgical treatment.
What is the success and what are the risks of this procedure?
With a good preliminary assessment and a highly educated and experienced team, the chances of success of the intervention are high and reach the figure of about 98%.
In some patients, however, complications may occur. They may be of a prosthesis displacement kind, or complications from other organs and systems like the kidneys, the lungs, the brain, or eventually injury to the aorta. In these rare cases, further treatment is being additionally considered, whether interventional, surgical or with medications. But in general, the percentage of bad outcomes or a death is very small, almost negligible.
In the Clinical hospital Zan Mitrev, the angio team of experienced doctors consisting of: Dr. Vilma Ampova-Sokolov, Dr. Ivan Milev, Dr. Shpend Idrizi, Dr. Nikola Hristov, together with the nurses Sonja Rusevska, Vesna Milev and Suzana Kostovska, continuously and successfully perform the TAVI procedures.
Last month, the urological team from the Zan Mitrev clinical hospital consisting of Dr. Goran Jovic, and the doctor on specialization, Dr. Viktor Grujevski, with the nurse Aleksandra Ristovska – Tunev, paid an educational visit to the Medipol Hospital in Istanbul. The purpose of the visit was to participate in the performance of several lithotripsy – surgeries for breaking kidney stone, using the Jeta laser device. During the surgeries, which our team attended, crashing of kidney stone, as well as a stone in the urethra, were performed, during which specific experiences and guidelines on the methodology to perform these procedures were shared. At the same time, techniques were developed and applied for removal of the bladder and prostate tumors.
After this educational procedure, our team is ready to perform these surgeries with the Jeta laser device, that we have in our hospital.
Have you ever heard about a lithotripsy?
Sounds complicated and strange to you? It is actually a procedure for breaking stones (calculi) in the urogenital areas using a laser device.
The problem of calcium deposits existence, which create stone formations of different sizes, is frequent one, and can be very disturbing and painful. Most often, except with severe pain in the lower abdomen, it can be manifested by the presence of blood and even small pieces in the urine. These stones can also cause infections that can lead to various urinary tract problems.
The presence of stones is diagnosed by echo of the urethra, the bladder or the kidneys, after which the doctor will recommend the following steps to resolve this problem. At the Zan Mitrev clinical hospital, we use a laser to break stones in the urogenital tract, which is effective for the treatment of all different types and chemical compositions of stones and is an optimal solution, even for those stones that are particularly difficult to access. The procedure is performed in the hospital by a properly trained urologist.
This approach is a great alternative to the traditional lithotripsy because it involves a lower risk of complications and a higher degree of efficiency and safety, regardless of the type of stones that are be treated. Compared to the other surgical procedures, it has the undeniable advantage of minimizing the bleeding and the stone movement (retropulsion) during the surgery.
There are many benefits for patients, and some of them are:
Minimum invasive method
The symptoms resolve immediately
Very short recovery time and return to the everyday activities
The clinic has a unique approach with free surgeries for the cardiovascular patients, for over 20 years. The successful cooperation with the Public health fund for the cardiac surgery patients, enables the patients to receive these top services for free.
The top services of the modern medicine, the results based on fast and accurate diagnosis, the disease prevention, the performing complex surgeries – are our mission for which we exist, always focused on the work, in order to increase and to expand the club of content patients.
In, the distant, year 2000, in a rented part of the Military Hospital in Skopje, the outlines of the special hospital for surgical diseases “Filip Vtori” were set-up. That was our baptism by fire, marked by the first bypass surgery in the Republic of Macedonia, led by academician D-r Zan Mitrev.
Today, the Zan Mitrev clinical hospital has a great reason to celebrate – the marking of its 22nd anniversary of existence. It is a true example of a vision made true, which was to provide a top medical service in accordance with the highest standards of a world class. From the very beginning, the clinic has set high standards and has opened new horizons in the Macedonian cardiovascular surgery. The surgery room, with which we started, with 12 hospital beds, has grown into a state-of-the-art medical center, with complete diagnostic procedures in most of the medical branches, supported by services of the modern surgery, anesthesia and intensive care.
The Zan Mitrev Clinical Hospital is located in a new, ultra-modern facility, an investment, 40 million euros worth, in which the main mission is to focus on the development of the hospital and achieving the highest possible quality of services. The clinic covers 17,000 square meters, it has several operating rooms at disposal, intensive care and semi-intensive care units. It is intentionally designed and built, according to its purpose and it meets the highest environmental standards, without any CO2 imprint. It is completely digitalized, the paper is almost never used in the everyday operation. The clinic continuously follows the latest trends and standards, in terms of improving of the operation processes and the safety of patients, from medical malpractice and from nosocomial infections. “A proof of the success is the fact that in 2020, even though in time of a pandemic, for the second time we have received an accreditation with a gold seal, from the “Joint Commission International”. Following the new technology in medicine, the clinic relays with the most contemporary medical devices, such as the lithotripsy urological laser, the state-of-the-art diagnostic devices for magnetic resonance imaging, computed tomography imaging and for 3D tomosynthesis mammograph.
In this past period, the necessity for regional presence had also emerged. That is why in the last year, we opened two large diagnostic centers, under the brand of “Zan Mitrev Diagnostic”, first in Strumica, and then in Bitola. Namely, the previously existing polyclinics were completely refurbished, rebranded, with expanded capacities and number of activities. They are equipped with the most technologically advanced devices CT, MR, RTG, EHO. Detailed blood tests are performed in the biochemical laboratories. They also have a daily hospital for patient care, as well as ambulances. The purpose of opening such centers is to guarantee the level and the quality of our services locally and of course, to help the patients to feel better, safer and happier.
We are also proud of our new investment – the Center for aesthetic dermatology, which is a comprehensive medical and cosmetic – dermatological section, that offers a full range of medical and surgical care, as well as aesthetic improvement, – says the head of the Clinic, academician D-r Zan Mitrev.
The Zan Mitrev clinical hospital continuously invests in permanent upgrading and education of its employees, creating top staff ready to face all challenges.
“Following the new technology in the medicine and working with the latest medical devices, we are creating our staff here, which is a very long-term investment on which our excellent results are actually based. Realistically, we have doctors who are far more prepared and with much higher professional performance than many doctors in Germany” – says academician D-r Zan Mitrev.
Among the first in Europe, the Zan Mitrev clinical hospital has set up a genetic laboratory and brought together various genetic tests in routine daily practice. In out laboratory we test the most common 33 pathogenic bacteria and viruses upon the patients` admission in hospital, including the COVID SARS tests. The combination of the individual approach with pharmacogenetics i. e. tolerance / intolerance to certain drugs, was the beginning of the application of personalized medicine, specific to each individual patient, thus preventing any eventual fatal consequences for patients. The Zan Mitrev clinical hospital was the first to start with the application of blood purification or the so-called haemofiltration, which is now being also implemented in patients who are struggling with severe consequences caused by the corona virus.
What makes this clinic special is the unique approach with free surgeries for patients for heart and blood vessels` diseases for more than 20 years. The successful cooperation with the public healthcare fund, for the cardiac surgery cases, provides the patients an ability to get these services for free.
“I think that even after so many years, the people know very little, what do we actually have here in terms of health conditions and standards. I have established a daily work routine and treatment of the most seriously ill, with the highest standards applied. I managed to make these services to be covered by the Public health insurance fund, so the patients to be treated without having to pay additionally. Although only in the area of cardiac surgery, this is still an example, i. e. shows the size of the development potential of the health care, if the functioning conditions undergo change” – explains academician D-r Mitrev.
The Zan Mitrev clinical hospital is a classic example of achieving a vision, a concept that has been painstakingly made true and is an example for many young people that great things can be done, as well, here, at home. In fact, a unique connection has been made between the medicine and business. On one hand, to provide a top medical service in accordance with the highest established standards in the world, to make it accessible to any patient, but at the same time to provide an economic profitability.
For more than two decades, the patients in our country are receiving top medical services in accordance with the highest world standards.
The clinic has a unique approach with free surgeries for the cardiovascular patients, for over 20 years. The successful cooperation with the Public health fund for the cardiac surgery patients, enables the patients to receive these top services for free.
The top services of the modern medicine, the results based on fast and accurate diagnosis, the disease prevention, the performing complex surgeries – are our mission for which we exist, always focused on the work, in order to increase and to expand the club of content patients.
In, the distant, year 2000, in a rented part of the Military Hospital in Skopje, the outlines of the special hospital for surgical diseases “Filip Vtori” were set-up. That was our baptism by fire, marked by the first bypass surgery in the Republic of Macedonia, led by academician D-r Zan Mitrev.
Today, the Zan Mitrev clinical hospital has a great reason to celebrate – the marking of its 22nd anniversary of existence. It is a true example of a vision made true, which was to provide a top medical service in accordance with the highest standards of a world class. From the very beginning, the clinic has set high standards and has opened new horizons in the Macedonian cardiovascular surgery. The surgery room, with which we started, with 12 hospital beds, has grown into a state-of-the-art medical center, with complete diagnostic procedures in most of the medical branches, supported by services of the modern surgery, anesthesia and intensive care.
The Zan Mitrev Clinical Hospital is located in a new, ultra-modern facility, an investment, 40 million euros worth, in which the main mission is to focus on the development of the hospital and achieving the highest possible quality of services. The clinic covers 17,000 square meters, it has several operating rooms at disposal, intensive care and semi-intensive care units. It is intentionally designed and built, according to its purpose and it meets the highest environmental standards, without any CO2 imprint. It is completely digitalized, the paper is almost never used in the everyday operation. The clinic continuously follows the latest trends and standards, in terms of improving of the operation processes and the safety of patients, from medical malpractice and from nosocomial infections. “A proof of the success is the fact that in 2020, even though in time of a pandemic, for the second time we have received an accreditation with a gold seal, from the “Joint Commission International”. Following the new technology in medicine, the clinic relays with the most contemporary medical devices, such as the lithotripsy urological laser, the state-of-the-art diagnostic devices for magnetic resonance imaging, computed tomography imaging and for 3D tomosynthesis mammograph.
In this past period, the necessity for regional presence had also emerged. That is why in the last year, we opened two large diagnostic centers, under the brand of “Zan Mitrev Diagnostic”, first in Strumica, and then in Bitola. Namely, the previously existing polyclinics were completely refurbished, rebranded, with expanded capacities and number of activities. They are equipped with the most technologically advanced devices CT, MR, RTG, EHO. Detailed blood tests are performed in the biochemical laboratories. They also have a daily hospital for patient care, as well as ambulances. The purpose of opening such centers is to guarantee the level and the quality of our services locally and of course, to help the patients to feel better, safer and happier.
We are also proud of our new investment – the Center for aesthetic dermatology, which is a comprehensive medical and cosmetic – dermatological section, that offers a full range of medical and surgical care, as well as aesthetic improvement, – says the head of the Clinic, academician D-r Zan Mitrev.
The Zan Mitrev clinical hospital continuously invests in permanent upgrading and education of its employees, creating top staff ready to face all challenges.
“Following the new technology in the medicine and working with the latest medical devices, we are creating our staff here, which is a very long-term investment on which our excellent results are actually based. Realistically, we have doctors who are far more prepared and with much higher professional performance than many doctors in Germany” – says academician D-r Zan Mitrev.
Among the first in Europe, the Zan Mitrev clinical hospital has set up a genetic laboratory and brought together various genetic tests in routine daily practice. In out laboratory we test the most common 33 pathogenic bacteria and viruses upon the patients` admission in hospital, including the COVID SARS tests. The combination of the individual approach with pharmacogenetics i. e. tolerance / intolerance to certain drugs, was the beginning of the application of personalized medicine, specific to each individual patient, thus preventing any eventual fatal consequences for patients. The Zan Mitrev clinical hospital was the first to start with the application of blood purification or the so-called haemofiltration, which is now being also implemented in patients who are struggling with severe consequences caused by the corona virus.
What makes this clinic special is the unique approach with free surgeries for patients for heart and blood vessels` diseases for more than 20 years. The successful cooperation with the public healthcare fund, for the cardiac surgery cases, provides the patients an ability to get these services for free.
“I think that even after so many years, the people know very little, what do we actually have here in terms of health conditions and standards. I have established a daily work routine and treatment of the most seriously ill, with the highest standards applied. I managed to make these services to be covered by the Public health insurance fund, so the patients to be treated without having to pay additionally. Although only in the area of cardiac surgery, this is still an example, i. e. shows the size of the development potential of the health care, if the functioning conditions undergo change” – explains academician D-r Mitrev.
The Zan Mitrev clinical hospital is a classic example of achieving a vision, a concept that has been painstakingly made true and is an example for many young people that great things can be done, as well, here, at home. In fact, a unique connection has been made between the medicine and business. On one hand, to provide a top medical service in accordance with the highest established standards in the world, to make it accessible to any patient, but at the same time to provide an economic profitability.
