Interventional cardiology is one of the areas of medicine that we can be proud of. We are at the forefront of Europe in terms of the effective treatment of heart attacks. We talk to prof. dr. hab. n. med. Radosław Stefan Kiesz.
Interventional cardiologyoffers the possibility of treating many cardiovascular diseases without opening the chest, providing doctors with a lot of professional satisfaction. But it is even more important for patients who not only escape death, but also recover faster and recover fully. We talk to prof. dr. hab. n. med. Radosław Stefan Kiesz.
- The cardiovascular system is like a hydraulic system …
Prof. Radosław Stefan Kiesz: Yes. In the United States, where I work on a daily basis, we call interventional cardiologists or endovascular specialists as plumbers. Simply put, it means that where a pipe becomes clogged, it must be unplugged. If this tube is in the heart, we have very little time to open it to prevent damage to the heart muscle. The hydraulic system works in tandem with the electrical system, which enables the heart to contract and therefore pump blood. Metaphorically so, of course.
- What is the weakest and what is the strongest side of this system?
R.S.K .: Heart attacks usually develop between 8 am and 10 am or between 2 am and 3 am. Depending on the extent of the heart attack, we have about 2 hours to be rescued. During this time, the patient should go to a specialist center where "plumbers" will be able to open a clogged coronary vessel, restore blood flow, and thus reverse damage to the heart muscle. The weakness of the heart muscle is that if we do not intervene quickly enough, damage to the heart will lead to electrical instability, develop ventricular fibrillation, and the patient will die. Even if it survives, a large part of the heart will die, a large scar will form, and he will develop ischemic cardiomyopathy. A person with such a condition has a failing heart and is practically an invalid. Once upon a time the only onethe salvation for these people was heart transplantation. Currently, we also have other options for saving these patients.
- What are these options?
R.S.K .: When I came to Poland after 1990, I visited many hospitals here. I learned from my colleagues that although there are many cardiology departments in the so-called provinces, people die of heart attacks en masse. Then I suggested to my colleagues the creation of interventional cardiology centers in small towns, which would treat heart attacks in a modern way. And because I have learned the principles and technique of stenting, invented by my friend, prof. Julio Palmaz, I wanted stents to be used in Poland as well. This is how a network of hemodynamic laboratories was created, where lives can be saved with relatively little expenditure. We can reverse the effects of a heart attack and, after a short hospitalization, the patient returns to a productive life.
- And where did you get the stents from? After all, they were not in Poland at that time.
R.S.K .: I brought them in a suitcase from the States. More than once, the patient was on the table and the customs officers were still checking my luggage. In 2001, we published the results of our medical observations, which opened the way for stents to Polish hospitals. Over time, it turned out that patients with metal stents experienced restenosis, i.e. the vessel closed again. With conventional stents, restenosis develops in 50-60% of patients, while in diabetics in 70%. The patient came back to us. That is why we have been working on such stents that would be armed with cardiological drugs. It worked, and the advantage of drug-coated stents is that only 1-2% of patients experience restenosis.
- Do drug stents only protect against restenosis?
R.S.K .: Drug stents solve a patient's he alth problems in 98%. In medicine, nothing is 100% certain.
- How do you evaluate the treatment of heart attacks in Poland?
R.S.K .: I believe that this is the best treatment system in Europe and maybe even in the world. Usually, 20-30 minutes pass from the first symptoms of a heart attack to the arrival to the hospital. In the USA, we are happy when a sick person reaches the hospital within an hour. If you have a heart attack, it's only in Poland, because the sick person has the best chance of survival. Much bigger than in London or Paris. The planned financial cuts will destroy this system. In Poland, many procedures that are already standard in other countries are still not financed, e.g. rotablation - that is, a procedure in which you can clear vessels blocked with calcified atherosclerotic plaque.
ImportantStents save not onlyheart
Stents can be implanted not only in the coronary arteries. Professor Radosław Stefan Kiesz implanted a stent in the carotid artery - it was the third such procedure in the world. Stents can also be inserted into the iliac or renal arteries, and placed in the superficial leg arteries - although in this case, due to the movements we make while walking, other techniques for clearing the blood vessels below the knee work better than stents. They are also used in the treatment of strokes.
- You have performed the first acute angioplasty in Poland. Do you remember what it was like?
R.S.K .: Of course, although that was 30 years ago. At that time, I was working in the hospital at Pica Spartańska in Warsaw as a senior assistant to the then doctor, Witold Różyła. A doctor from a trip to Zurich from Professor Andreas Gruntzig brought several catheters for ballooning vessels. I was on duty then, and all our bosses were taking care of the delegation of very important people who visited the hospital. The ambulance service brought a patient whose friend was performing catheterization, but the right artery of the heart was blocked during the procedure. The patient developed a massive infarction, the man went into cardiogenic shock. I decided to open the artery. I inserted a catheter into a coronary artery, took the balloon, and pushed it open with oxygen. The artery was opened, the infarction turned before our eyes, the skin turned pink, the patient did not complain of pain. I did a coronary angiography, but the artery stenosis was still severe. I didn't like it, so I widened the artery with another balloon. The next day I was accused of catheter failure. After a few years, I learned from Professor Gruntzig that I had performed the world's first cardiogenic shock angioplasty.
- So it is worth investing in interventional cardiology?
R.S.K .: Of course it's worth it. The rescued patient can not only continue his professional career on his own, but also will not receive a pension and will not be a burden for the family. It often happens that a sick person must be taken care of by the closest family members, who must devote all their time to him, quitting their job. However, it is important to remember that every patient is different and effective treatment is based on considering these individual needs. I keep hearing about personalizing treatment, but I don't see it in practice. I look at the situation in Poland from the Texas perspective, but this allows me to remain objective. If someone tells me that I should only use the old metal stent because it is cheaper, I do not agree to it, because it is an unethical act, carried out against medicinebased on evidence.
ImportantFewer fatal heart attacks
Twenty years ago, 25% of heart attacks in Poland resulted in the patient's death. Now the death rate has dropped to 5.6%. This is a very good result - fourth among OECD countries, where the average is 7.8%. In the centers concentrated in the Polish-American Heart Clinics, the peri-infarction mortality is 1-1.5%. When the patient arrives at the hemodynamic center late and is in the so-called cardiogenic shock, the mortality rate exceeds 90%. But doctors are also able to remove the sick from such conditions. Then, apart from stenting, it is necessary to use devices that support circulation.
Co-founder and vice-chairman of the supervisory board of American Heart of Poland. AHoP is the Polish-American Heart Clinics - a network of over 20 specialized departments of interventional cardiology, cardiosurgery and vascular surgery in Poland.
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