In the rhythm of the heart

For 20 years, our country has made a breakthrough in cardiology and cardiac surgery

For the past five years, the Republican Scientific and Practical Centre ‘Cardiology’ has been carrying about 50 transplants a year. Based on 1 million population, this is 5 times more than, for example, in Russia, Poland or Germany. In addition, completely new techniques have now appeared that are not so radical, but act as a surgical bridge to the future of heart transplantation. They are minimally invasive. Doctors took on severe patients in cardiogenic shock, practiced suppression of immune responses, learned how to deal with pulmonary hypertension, and mastered operations to remove blood clots from the lungs: a severe pathology in which blood clots fly off into the airways and gradually clog the lumen.

Photo by Aleksei Matyush

From unique to standard

Director of the Republican Scientific and Practical Centre ‘Cardiology’ Natalya Mitkovskaya notes that even COVID-19 did not significantly affect the development of cardiology in Belarus. For example, in 2020 there were performed more heart transplants than in the previous year. And in 2021, 3,500 open-heart surgeries and 18,500 cardiac interventions in general were performed in Belarus.
With regard to emergency assistance, we look more than worthy amid the UK, other European countries, and America, having reduced the activity for carrying out planned operations by less than 10 percent. While in some countries this decline has reached 50 percent.
The Republican Scientific and Practical Centre ‘Cardiology’ performed its 500th heart transplant this July, with the very first in 2009.
The idea of this method of treatment matured among Belarusian specialists by the end of the 1980s, but at that time they were not technically ready. In 2007, a law was passed in our country, thanks to which organ retrieval is possible on the basis of a presumption of consent. It was then that transplantation began to be popularised as the only radical method of treatment. It was necessary to learn from foreign colleagues’ experience in logistics, heart transplantation, and immunosuppressive therapy of patients. Three brigades went on foreign internships. Deputy Director for Innovative Development and High Technology of the Republican Scientific and Practical Centre ‘Cardiology’, Academician of the National Academy of Sciences, twice winner of the State Prize of Belarus Yuri Ostrovsky specifies, “As a result, we created our own protocol and in February 2009 we did the first transplant. It was successful.
A lot has changed in 13 years, and this operation is now quite standard. We are among the top 20 world centres in terms of the number of transplants, even surpassing our teachers.”

Exquisite workmanship

With the active participation of the Director of the Minsk Centre of Surgery, Transplantology and Haematology Oleg Rummo, who organised the coordination service throughout Belarus, liver, kidney and heart transplantation began to develop simultaneously in 2009.
A large team is involved in the fateful process. Its first link is local resuscitators who see that the brain of a potential donor has died, and further treatment is futile. They inform the coordinators about this, they go out, examine, do tests, including for apnea. In addition, if brain death is confirmed, the transplantologists are told, then the cardiac surgeons get down to business.
The harvesting team is on its way. 

Photo by Aleksey Bibikov


An important thing: the ischemia of the motor of the heart lasts only four hours, during which time the organ must be brought and launched. Therefore, a helicopter is sent to remote areas of Belarus, and biological tissues ‘move’ exclusively within the country. Often there is an ultrasound diagnostician in the team who evaluates the suitability of the heart for transplantation.
Not only delivery, but also the work of the surgical team during sampling and implantation requires time, therefore, based on world experience, our specialists create their own myocardial protection system. This new container will maintain the most ideal heart temperature of 4 to 6 degrees. In this case, the safe ischemia of the donor organ will increase up to six hours.

Complex set

The first year after a complex operation is the most problematic. Due to immune suppressing drugs, the risk of infection is high. After transplantation, patients are observed at the Republican Scientific and Practical Centre at least once a year, or even more often. Moreover, all drug provision with regard to immunosuppressive therapy is taken over by the state, that is, it is completely free for a person. After any heart surgery, including after myocardial infarction, rehabilitation is required. 
In terms of life expectancy for people with a transplanted heart, our standards are the same as those of the world: a 10-year survival rate is 68 percent.
But each case is different. 
In 2016, the Republican Scientific and Practical Centre ‘Cardiology’ transplanted the heart-lung complex for the first time. Everything went well. Double transplantation is a last resort, which is used in very severe patients. But it gives them a chance to survive.
“We carried heart-kidney transplants, and now we are thinking about transplanting the heart-liver complex together with the Minsk Centre of Surgery, Transplantology and Haematology. It is a technically very difficult procedure, but sometimes it is the only hope,” explains Yuri Ostrovsky.
By the way, high technologies are also progressing in the regions. There are surgical units in each region, where at least 70 percent of all operations are performed. 
In Mogilev, they used to carry kidney transplantation, and now heart transplantation. After all, doctors are always focused on reducing the time of ischemia of a donor organ. In this case, the donor and recipient were from Mogilev, and the ischemia time was only an hour and a half. 

The number of operated patients in the Republican Scientific and Practical Centre ‘Cardiology’
2018 — 2,971
2019 — 2,791
2020 — 2,422
2021 — 3,089

Belarusian developments

Our cardiac surgeons cope with cardiac operations of any complexity, using domestic mechanical heart valve prostheses. They have been used since 1993, have changed significantly over time and now have ideal parameters. 
But in our country, a new development is underway — biological prostheses, which are best suited for patients over 65 years old, because they do not require additional drug therapy. Clinical trials of these new products will begin soon.
Even in our country, artificial heart ventricles have long been used. They are very expensive, one is about €150,000, and you need up to 50 such systems per year. It is for this reason that our specialists began to develop domestic systems.
PHOTO BY ALEKSEY BIBIKOV

Rockefeller, who had survived seven heart transplants by the age of 102, did not ask our doctors for help, but other foreigners willingly do this. The priority is for fellow countrymen, but the heart should fit the patient, it cannot be transplanted from a small woman to a large man — it will not handle the load. The heart, like any other organ, is selected according to height, weight, blood type, immune compatibility, and the risk of rejection is studied by a cross-match test. In such cases, when there are no Belarusian candidates or a foreigner’s condition is much worse and borders between life and death, they are rescued out of turn. In a word, the approach is individual. The cost for foreigners is lower compared to world prices, and it is free for Belarusians. 
The Republican Scientific and Practical Centre ‘Cardiology’ turns 45 years in 2022. As the First Deputy Healthcare Minister Yelena Krotkova emphasised, a lot has been done over the years, a high combination of practice, science and education has been achieved. 
There are nine scientific and practical departments, more than 700 employees who provide practical assistance. More than 20,000 patients receive advisory assistance and 5,000 receive inpatient care. More than 200 specialists of practical healthcare not only in our country but also in other countries are trained annually.

Fact
In 2021, 3,500 open-heart surgeries and 18,500 cardiac interventions in general were performed in Belarus

By Yelena Basikirskaya