In an interview, Professor and Doctor of Medical Sciences Igor Pershukov shares his views on the significance of hybrid operating rooms for reducing costs in invasive cardiology and cardiac surgery, while also paying tribute to the classic ideas of N.G. Chernyshevsky and N.V. Gogol.
- I.V. Pershukov – Professor, Doctor of Medical Sciences, Head of the Department of Hospital Therapy with a Course in Radiation Diagnostics and Oncology at Jalal-Abad State University.
- Why the focus on hybrid operating rooms in cardiology?
- A plan for the development of the cardiology service has been approved in Kyrgyzstan, which includes the opening of new catheter laboratories (cat labs) in regional centers and large districts.
These cat labs will train young specialists to work in interventional cardiology operating rooms. However, the question arises: how will they function in emergency situations when immediate open-heart surgical interventions may be required?
Firstly, who should act in the event of complications — an interventional cardiologist or a cardiac surgeon?
Secondly, how should a young doctor in the radiological operating room proceed if there is a need for non-standard solutions? Will he follow recommendations or apply his skills to save the patient?
- How to deal with such complications?
- At first glance, it might be possible to organize the delivery of patients by helicopter to one or two centers where experienced cardiac surgeons work. But ensuring constant helicopter standby near each laboratory is impossible — this would entail significant costs for equipment and maintenance.
If air ambulance services are concentrated only in two reference centers in the country, then in an emergency situation, time will be required for the flight back and forth, which could be critical for the patient. There are no guarantees that this time will be sufficient to provide assistance.
- So what should be done then?
- Interestingly, solutions to this complex problem were found back in 1993 in the eastern part of Turkey, in the city of Adana. A young candidate of medical sciences, Talantbek Batyraliev, and his team of cardiologists and cardiac surgeons (including Mustafa Polat, Erdogan Demiray, Mesrur Zan, as well as Yuri Pya and Zarema Niyazova from the Kyrgyz Medical School) opened a hybrid cardiology and cardiac surgery service at Özel Adana Ortadoğu Hastanesi.
In this hybrid operating room, angioplasties and stent placements were successfully performed, as well as emergency open-heart surgeries, including rare but serious complications from heart attacks or the consequences of stenting.
Yuri Vladimirovich Pya, Mustafa Polat, Erdogan Demiray, Mesrur Zan in the hybrid operating room in Turkey, Adana, Özel Adana Ortadoğu Hastanesi. - Photo from the archive
This service became one of the first in the world and demonstrated its effectiveness in solving angiography and cardiac surgery procedures, while also ensuring a high level of safety in emergencies requiring cardiac surgical support.
Not only in Turkey but also beyond its borders, the significance of such a hybrid service has been noted. Since 2001, Professor B.A. Sidenko, Chief Cardiologist of the Central Clinical Hospital of the Administration of the President of the Russian Federation and Head of the Department of Cardiology and General Therapy at the Central State Medical Academy, has advocated for the scaling of such solutions and has repeatedly visited this service.
In his lectures, Professor Sidenko emphasized the high level of organization of cardiology and cardiac surgery activities in a unified space, inspiring colleagues from Russia and other countries who also visited this clinic.
- Why hasn't hybrid surgery become widespread?
- Perhaps this is related to the peculiarities of human perception. The idea of transferring the experience of "some" clinic in Turkey might have seemed overly laudatory. Perhaps this is why the mass development of hybrid surgery began significantly later.
Now, more than 30 years later, Kyrgyzstan faces a similar task at the national level, and the experience of hybrid cardiology and cardiac surgery from the 90s in Turkey is extremely relevant.
- How useful is the experience of Özel Adana Ortadoğu Hastanesi today?
- It is more than useful! It should be noted that in different countries, the concept of hybrid cardiology and cardiac surgery is often reduced to a narrow meaning, where doctors of different specialties work at the same operating table. However, hybrid surgery has a much broader meaning.
It is the integration of various operating rooms into a single complex with a shared recovery area, reducing distances between operating rooms and recovery wards, as well as access to necessary equipment for both services. Wards where patients with cardiological problems are treated should be located close to the operating block to ensure quality monitoring and treatment.
This integrated module does not increase costs; on the contrary, it reduces them by speeding up the provision of assistance and lowering the risk of complications.
In such comprehensive work, cohesion is formed — both in the manipulations of doctors and in the preoperative selection of treatment strategies that take into account the patient's opinion.
Considering the experience of my mentor Talantbek Batyraliev, I see that the complex conditions of Kyrgyzstan require the adaptation of recommendations developed for other regions, where completely different realities are taken into account.
Unfortunately, ready-made solutions for Kyrgyzstan simply do not exist, and here artificial intelligence will not help. The development of funding for such programs must take into account many factors, including state guarantees and insurance.
- How to act in this situation?
- Of course, one can ignore all this, as some international guidelines allow for the absence of cardiac surgical support on site. However, it is important to remember that the distance to a cardiac surgical clinic plays a key role in every region.
As long as young doctors make mistakes in radiological operating rooms, it leads to loss of life. A hybrid operating room will be cheaper than maintaining a rescue helicopter, even considering the costs of equipment maintenance.
Speaking of aviation, the question arises: where to find a sufficient number of pilots willing to work in any conditions? Manas Airport operates only in good weather, while round-the-clock flights are required even in heavy snowfall and poor visibility.
This reminds me of the great Russian writer Nikolai Gogol and his work "The Marriage": "If only the lips of Nikanor Ivanovich could be pressed to the nose of Ivan Kuzmich, and to take some of the boldness that Baltazar Baltazarych has, and perhaps add to this the corpulence of Ivan Pavlovich — I would then immediately decide."
