Cardiovascular Surgery Department

Department of Cardiovascular Surgery of Erebouni Medical Center was created with purpose to provide surgical care to patients with cardiovascular diseases. Cardiovascular surgery involves the surgery of the heart and great vessels.

The department is carried out:

• coronary artery bypass grafting, including  the use of both internal thoracic arteries (bilateral mammary grafting using composite Y-graft technique),
• plastic surgery of postinfarction aneurysm of the heart by Dor's technique
• plastic surgery of the heart valves,
• prosthetic heart valves with the use of high quality prosthetic valves manufactured by Sorin,
• surgical correction of some congenital heart defects (i.e. septal defects)
• removal of tumors of the heart,
• surgery of pericarditis
• surgery of the carotid arteries - endarterectomy
• surgery on peripheral vessels
• laser vascular surgery
• surgery on the thoracic and abdominal aorta

Department of Cardiovascular Surgery of MC Erebouni first time in Armenia began to carry out cardiac surgery for postinfarction heart aneurysm with Dor’s technique with good results, corresponding to international standards. This cardiac surgery in its effectiveness is equivalent to a heart transplant, and not only saves patients' lives, but also extends it for decades, improves the quality of life.

After a heart attack, the cardiomyocytes of damaged area of the heart do not regenerate, and are replaced by scar and connective tissue, which, due to its specificity, is not participate in the contraction of the heart. Moreover, it is less resistant to changes in hemodynamics and increases of pressure in the chamber. Over time, the damaged area of the myocardium begins to stretch, thins and evaginates, forming a heart aneurysm. If this situation is untreated, it can lead to serious complications, including death in the short period of time:

• The sharp decline in cardiac output and severe heart failure,
• Recurrent myocardial infarction,
• Thrombosis of the left ventricle
• Thromboembolism in different arteries, including the brain, with development of stroke,
• Rupture of aneurysm with massive hemorrhage,
• Cardiac tamponade,
• Recurrent ventricular arrhythmias,
• Cardiac arrest and sudden cardiac death.

Elimination of the aneurysm of the left ventricle can only be surgically - by geometrical reconstruction of the left ventricle by Dor's technique.

The indication for surgery is the presence of an aneurysm, which is manifested by one or more symptoms: retrosternal pain, dyspnea, arrhythmia, congestive heart failure and others. The geometric reconstruction of the left ventricle with intraventricular patch (Dor's operation) is also performed in ischemic cardiomyopathy with a large area of akinesia or dyskinesia of the left ventricular myocardium.

 
The Coronary bypass using both internal mammary arteries (bilateral mammary grafting using composite Y-graft technique)  for the first time in Armenia was also performed in the Department of Cardiovascular Surgery, MC Erebouni. This method of cardiac surgery has long been used successfully in leading foreign clinics, but only recently has been introduced in cardiac surgery practice in Armenia. For today, a lot of patients successfully already had been operated in MC Erebouni with use of this technique with results identical to the international standards. In contrast to coronary artery bypass grafting which uses the venous shunts the usage of mammary arteries for this procedure gives better results because they are less undergoes to proliferative reaction, well dilates under the influence of various pharmacological agents and not gets spasm under the influence of norepinephrine.

This arterial bypasses are functioning close to patient's own coronary arteries. This reduces the likelihood of thrombus formation in them in the postoperative period, thus decreasing the probability of repeat cardiac surgery. This is a very important factor, especially when patients of young group undergo to surgery.

Next service included to the department of cardiovascular surgery is Vascular Surgery of the Neck and Head, which was created in January 2014. It is the only one in Armenia, whose activities are aimed to prevent such serious diseases, as ischemic stroke by correcting stenosis of blood vessels of the neck. The stenosis of neck vessels in 80% of cases are the reason for ischemic stroke development. However, according to statistics, in Armenia, from the 1500-2000 patients with indication for correction of stenotic vessels of the neck in order to prevent the development of ischemic stroke the surgical treatment gets only 15-20

Today in Armenia the stroke and pre-stroke conditions are treated dominantly with the use of pharmacological agents, which did not gives expected results and did not prevents repeated cases of stroke.
During the year of activity of the department it has surgically treated more than 80 patients. Monthly it is about 7 - 10 patients who gets surgery for stenotic vessels of the neck. Basing on increasing amount of the patients and with purpose of prophylaxis of development of ischemic stroke the department is planning to increase the number of patients up to 80-100 per month or more than 1000 per year.  

Thus the Department of Cardiovascular Surgery integrates the following services:
-  cardiac surgery and heart reconstruction unit
-  neck vessel surgery and stroke prevention unit
-  aortic surgery unit
-  peripheral vessels surgery unit
-  vessels laser surgery unit

Department of Cardiovascular Surgery of Erebouni MC is equipped with all necessary modern equipment. Specialists of department had been trained in well-known foreign cardiac surgery centers. The integrated multidisciplinary team of multiprofile specialists, which conducts highly complex combined surgical intervention had been created at the Department.