DR CHRISTOS EFTUXIOU - ROUTINE [HEART] OPERATIONS WITH THE TAVI METHOD

 Filenews 23 August 2020 - byGiannis Antoniou 

Transdermal Aortic Valve Implantation (TAVI), a pioneering method of replacement of the aortic valve, is now systematic in Cyprus, for cases of severe symptomatic stenosis, without the patient undergoing open surgery. In 2019 78 cases were carried out in the Cardiological Clinic of the Nicosia General Hospital, while in 2020 – despite the interruption due to COVID – there have already been 46. "The outcome and outcome rates of the Nicosia General Hospital are the same as those of the major centres of Europe and we have published them in international conferences and authoritative medical journals", states in "F" the interventional cardiologist, Dr Christos Eftuxiou, Assistant Director of the Cardiological Clinic of GN Nicosia, (OKY), Doctor of Medicine of the National and Kapodistrian University of Athens and Special Scientist of the Medical School of Cyprus.

-What exactly is Transdermal Aortic Valve Implantation (TAVI)?

- It is an innovative method of replacement of the aortic valve that is indicated in cases of severe symptomatic stenosis, without the patient having surgery. It has now been established as a safe and effective option for aortic valve stenosis, and more and more patients are being treated with this method.

- What causes the stenosis?

-The most common cause of aortic valve stenosis is degenerative and most commonly affects the elderly over 70 years of age. Its classic symptoms are angina, syncope (loss of consciousness) and congestive heart failure. If symptoms appear severe aortic stenosis leads to death usually in 2-5 years.

- Are there enough such operations in Cyprus?

-The first TAVI operation in Cyprus was performed at the Nicosia General Hospital in 2010 by Dr. Avramidis, who is also the current director of our clinic and has been doing it systematically ever since. To date, some 375 such operations have been performed at the Nicosia General Hospital. In 2019 alone 78 cases have been carried out in our clinic and in 2020 despite the COVID interruption there have already been 46 cases. The outcome and results of the Nicosia General Hospital are equivalent to the major centres in Europe and we have published them in international conferences and authoritative medical journals. Since 2017 we have both the most widely used valves of the latest generation, used internationally, and we are the only center in Cyprus that is certified for the implantation of at least two different valves.

-How is it possible to select patients who need such surgery?

-The selection process is carried out in collaboration with the cardiosurgical and cardiological clinic of the Nicosia General Hospital. The operation is now performed, most of the time, without general anesthesia always with the participation of anesthesiologists and lasts less than an hour. A patient who will undergo TAVI without complications will be formally discharged two days later and will soon return to his usual activities.

-In addition to the TAVI procedure in the cardiology clinic, catheterizations are also performed, which are the usual procedures, right?

-The Department of Interventional Cardiology, the catheterization department as it is known, is one of the most important departments of the cardiological clinic of GN Nicosia. Here are the coroniographies for diagnosis and treatment of coronary heart disease and heart attacks, diagnoses and treatments of valvular and structural heart diseases as well as pacemaker implants and specialized electrophysiological studies. It is a clinic with a rich history in the Cardiology of the place, since here the first cardiac catheterizations and angioplasty were done by Dr. Zabartas and Dr. Nikolaidis, while in our clinic a large number of cardiologists who excel in Cyprus have been trained in the specialty of Cardiology. The main advantage of our clinic is the volume of our cases. Until now we have had by far the largest number of catheterizations in general but also especially of primary angioplastics in the acute myocardial infarction. This is where the largest volume of cases of transdermal aortic valve implantation to which we referred is carried out.

In our clinic there are also specialized departments and dispensaries of imaging cardiology/ultrasound, electrophysiology/arrhythmology, congenital adult heart diseases, genetic cardiopathies and valvidopathies/structural heart diseases.

-The numbers of catheterizations, angioplastics and other operations that are done are on the rise. This obviously also demonstrates the extent of the heart problems that exist in Cyprus, does it not?

-Coronary heart disease is unfortunately a condition that also due to smoking, poor nutrition and lack of exercise we see it increase year after year. Let us not forget that cardiovascular disease is the leading cause of death, followed by cancers and infections. It is no coincidence that every year we are called upon to deal with more and more acute myocardial infarctions.

- Almost not a day goes by that we don't hear about a acquaintance who suffered an acute myocardial infarction. How is it cured?

-Primary angioplasty is the appropriate treatment for acute myocardial infarction and has been applied for several years in Cyprus in both the private and public sectors. The Nicosia General Hospital covers the provinces of Nicosia, Larnaca and Famagusta and responds to about 350-400 incidents a year at any time and day of the year. The patient who has suffered a heart attack is immediately taken to the catheterization laboratory for coronary and angioplasty with stent placement for the opening of the blocked artery. This practice has been shown through studies to have better survival outcomes by saving more myocardial and thus fewer heart deficiencies. Also with primary angioplasty you have fewer strokes, fewer bleeds and fewer days of hospitalization than the thrombolysis used previously. All this, however, provided that this is done within two hours of the patient arriving at the hospital with an ideal time of less than 60 minutes.

-How much has the General Health System changed your daily life? To what extent does the competitive environment of OKYP hospitals work with private hospitals?

-Although it is often heard that public hospitals within the GHS are in a competitive environment, the truth is that, although this is a positive incentive for continuous improvement, our clinic has a very specific role to play. It is not intended to compete with the private dispensaries of our cardiological colleagues, but rather to come to offer those services that they need to deal with their difficult incidents and in consultation with them. That is, they will hospitalize their patient with the deregulation of heart failure, acute coronary syndromes and myocardial infarction that will need catheterization, will hospitalize the patient who will need pacemaker implantation, defibrillator or electrophysiological study. It will proceed to percutaneous implantation of an aortic valve or convergence of an intervaginal communication and the patient after completing the therapeutic interventions will return to his doctor for further follow-up.

- Have the incidents that come to you been reduced in practice?

-It is typical that during the period when the second phase of the GHS began, i.e. in June and July, the numbers of operations at least in the catheterization laboratory have remained at the same high levels. In this two-month period 371 catheterizations have been performed, of which 167 angioplasty and 62 are emergency, while 20 transdermal aortic valve implants (TAVI) and 79 pacemaker/defibrillator implants have been performed.

Many advantages

- Inevitably with the GHS, people now have choices. What do you think makes the cardiology clinic in Nicosia STAND out?

-Our advantage is our highly trained medical staff but also the excellent nursing, technical and paramedical staff, combined with the large volume of incidents we handle and which gave us the experience. Many times people give credit mainly to doctors for the successful outcome of a treatment. But in reality, especially for the type of operations we perform, our confidence relies heavily on experienced and trained staff who are either in catheterization laboratories or intensive care units and wards. I personally am proud of the high level of our nursing and paramedic staff. As far as our team of interventional cardiologists is concerned, we now have a fully trained team with experiences from England, Switzerland and Israel. Typically, two of our interventionists are scholars of the European Heart Association after a competition of cardiologists from all over Europe and with three winners a year. Also our interventionist holders hold postgraduate degrees and doctorates, all with rich writing work and presentations at international conferences. The existence of this group allows both the discussion and proper treatment of the most difficult incidents.

Of course, the existence of support structures such as intensive units and intensive care units, the anesthesiology department and clinics, such as the cardiosurgery and vascular surgery clinic that is always there for the treatment of complex cases and any complications, is an important prerequisite for the handling of high-risk operations.

-The interconnection of hospitals with universities is considered a milestone for the upgrading of medical services. How is the collaboration of the Cardiological Clinic of GN Nicosia with the Medical School of the University of Cyprus?

-Our clinic under the direction of Dr. Avramidis has welcomed with great pleasure our academic colleagues of the Medical School of the University of Cyprus, has allocated its spaces both for the practice of medicine by academics and for the education of students. Doctors of the clinic have been partners of the University of Cyprus for years and are actively involved in the education of students.

In collaboration with the department of molecular biology, there is a clinic of genetic cardiopathies and a clinic of heart failure which again works in collaboration with academics. Our cooperation with the Medical School we believe has a benefit for both our clinic and the University of Cyprus and our students and we look forward to its continuation and development.