It is not the first time we have spoken to Professor Paul R. Vogt. His schedule is extremely busy and this time Professor Vogt managed to find a few minutes for the conversation right before his next operation. While we were talking, the hospital was getting ready to accept a patient transported there by helicopter. In just a few minutes, one of the best cardiac surgeons in Europe was to start a major surgical operation – however, he looked perfectly at ease.
– Professor Vogt, can you tell me about this imminent surgery?
– It is a relatively young patient carried in by helicopter. He has an aortic dissection. The wall of an artery consists of three layers, and the innermost layer is actually a sort of ‘wallpaper’ that lines all the vessels to give a perfectly smooth surface. Suddenly the innermost wallpaper layer ruptures. The outer wall is still intact but it is only a matter of time as to when the entire aorta ruptures, which means immediate death. Such urgent situations require an aorta replacement as ninety patients out of one hundred with an aortic tear die within 24 hours. Aortic dissection is a classic emergency situation.
– What are the patient’s chances after this kind of surgery?
– The operative mortality risk is between 5–25% depending on what we find during the surgical procedure. Yet only 5% of patients can survive without surgery.
– What tools are available nowadays to prolong the heart’s work and lifetime? What are the latest inventions and innovations in this field?
– You can maintain your heart and thus prolong your life by doing cardiovascular exercises – you only need 150 minutes per week. The elderly and physically weak patients can be supported with pharmacological therapy. Should this not suffice, we still have two more options. The first one is a heart transplant, though it is suitable for a small number of patients only. The second option involves various devices, such as a mechanical pump implanted into the left cardiac chamber and connected to the aorta thus maintaining hemodynamics. It is known as left ventricular assist device (LVAD) implantation. This technique is not as widespread as, for example, pacemaker insertion. The weak point of LVAD systems is that they require a continuous power supply via the wires going through the skin’s surface. This destroys the infection barriers and imposes a risk of contamination. Moreover, the pump entai ls the necessity for constant hemodilution. Without dilution, the blood will coagulate in the device, which can cause a cerebral embolism eventually resulting in a devastating stroke. However, over one thousand devices have already been implanted in patients all around the world. Those devices are becoming more miniaturised and more powerful. With this machine, a patient can live for ten years without heart transplant surgery.
– What diseases is the implantation of such a device recommended for?
– When the heart can no longer be treated using traditional methods, or when the patient is living with severe chronic heart disease, or in the case of chronic cardiac failure, or when the consequences of a heart attack make themselves felt. Bed-bound patients can be discharged after surgery. The quality of life in this case can be described as rather good since it was initially a question of life and death. Sometimes such devices are implanted as a temporary solution for heart failure and after the situation improves it can be removed. However, we cannot say for sure whether the heart’s workings will go back to normal or not and we don’t know why some patients improve while others don’t. There have been cases when people live with this support device for several years, but later they must still undergo a heart transplant.
– How do you see the future? Will human heart transplants remain the best solution in worst-case scenarios or are scientists working on artificial heart solutions?
– The number of donor hearts is very limited. Far fewer than 10% of patients waiting for cardiac transplants find a donor organ. The population is aging and the number of people with heart diseases is growing. Support devices must become the optimal solution for most of them. Scientists are conducting research into possible transplants of hearts from different biological species but at the moment the human immune system is not ready for this kind of procedure. The second possible answer is to grow organs in the laboratory. Human cells would be immersed in biological solutions and they could grow into organs: for example, a heart. However, this method is far from being perfected, so today we still have only two methods to save people: human heart transplantation or LVAD insertion.
– Which of the methods you’ve mentioned will work reliably in the future?
– I am not 100% sure about either of the methods, as each of them has certain side effects, plus we cannot definitively predict what will happen in the future. In LVAD, energy transfer should be possible through intact skin, but this is merely an inkling of what might come to pass. We do not know when this will come to pass. There is still research underway: rather complex research that has been ongoing for many years.
– Researchers insist that ordinary people cannot live longer than 120 years. What is your opinion: if we have new instruments to support the heart’s functions, can the average lifetime be extended beyond 120 years?
– Theoretically, we can imagine this. But this must apply to all the other bodily organs as well – kidneys, liver, brain… Cell viability declines in all organs as well as in the immune system. With each passing year, a human being has less and less potency for fighting off infections. There are also other aging mechanisms that have not been properly studied yet. It is not always enough to perform cardiac surgery to stop the aging process. A heart transplant or device insertion cannot avert the weakness of the connective tissues – the bones, the joints etc.
– How do you maintain your quality of life?
– I am lucky: I do not have many risk factors. For sure, genes play an important role. I have to confess that my parents passed on very good genes to me. Some of my relatives are 90 years old and they are still enjoying an active lifestyle. With regard to physical performance, I do myself that which I propose to patients in a consultation. I do a lot of sports including cardiovascular exercises – they really can prolong a quality life by 10–15 years. The effectiveness of such exercises has been proven by numerous studies conducted for 30–40 years with over 1.5 million participants. We are not speaking just of getting older and older; we are speaking of living a productive life. Cardiovascular exercise means cycling, running, jogging (though running and jogging stress the joints); you can simply go to the gym and engage in cycling or an elliptical workout. You can buy a home treadmill and find twenty minutes a day for exercises. Those who want to will always find time for sporting activities. People with well-trained vessels contributing to their health throughout their whole life will even recover from surgery much faster.
– In what manner does stress affect the heart?
– Stress is my ‘favorite’ word. People try to justify their unhealthy lifestyle choices with the words, “I’m under stress” way too often, neglecting the aftermath of smoking, alcohol abuse, obesity or an unbalanced diet. Chronic stress does affect your health to a certain extent. But can it cause heart problems as a result? Maybe it will contribute around 3% compared to the other much more important risk factors. However, there is another acute form of stress. During an extensive adrenaline rush the heart can simply fail. This phenomenon is known as ‘broken heart syndrome’. In Japan, it is called ‘Takotsubo’, as the heart takes the shape of the Japanese octopus trap. This condition that we call ‘a broken heart’ actually exists! It is known that women are more prone to this syndrome than men. Many patients recover but not all of them. Symptoms of acute infarction are very similar to the symptoms of ‘broken heart syndrome’. Scientists understand the mechanism of this syndrome, but it is in no way related to what we usually call stress – work problems, chronic fatigue, etc.: those factors do not cause any failure in heart muscles, coronary vessels, or heart valves.
– Is it necessary to undergo regular tests and check-ups or does it only make sense to see a doctor after the symptoms occur?
– If we are talking about my surgical patients, they must come to see me at least once a year. However, there is no need for constant monitoring for those who do not have any risk factors and who exercise regularly. If the heart’s efficiency starts to reduce, a healthy person will notice it during a workout. Men aged 45 and over who’d like a check-up will have to mount a treadmill. It is almost impossible to reveal underlying heart problems in a resting state even if the patient’s coronary vessels are compromised: the heart must be put under physical stress. The first thing to do in such cases is bicycle ergometry – a treadmill workout with electrocardiography. The second option is a CT scan (computer tomography) of the coronary arteries, which allows us to detect atherosclerotic degeneration as well as any calcareous deposits in the vessels. If the coronary arteries do not show any calcifications in the CT scan, the risk of suffering from myocardial infarction during the following five years is negligibly low. If degeneration has been revealed the patient should undergo a test, as before: first the bicycle stress test, and, if positive, cardiac catheterization. Tomography helps to detect calcification but does not show the extent of the deposits. If the results of this series of tests are positive, the prognosis for the next year is good. However, we should take into account that coronary occlusion can occur within seconds in an absolutely healthy person. It is very important to understand that this is only an examination: it shows the condition of the heart and vessels in that given moment. If the CT and bicycle ergometry results confirm there is nothing wrong with your heart, it does not mean that tomorrow or in two years you won’t have a heart attack. This is why I think that the term ‘preventive examination’ is not only inappropriate, it is ridiculous. The examination does not prevent disease; this can only be prevented if you exclude risk factors and promote the physical activity of the patient. An examination is done at a certain moment in time and tells us the current status at that time. Prevention means life-long personal care for health by active, not passive, measures such as physical training. But of course, maintenance check-ups are advertised as prophylaxis and preventive care, because patients like passive measures and hospitals and doctors get money from them.
Paul R. Vogt
Doctor of Medicine, Professor of Cardiovascular Surgery, President of the EurAsia Heart Foundation. In 1983, he graduated from the Medical Faculty of the University of Zurich and then worked as an assistant physician in the field of heart surgery and vascular surgery at the University Hospital of Zurich under the guidance of Professor Marco Turin. In 1992, he defended his thesis. In 1997, he headed the Department of Heart Surgery and Vascular Surgery at the University Hospital of Zurich. In September 2020 he became Director of the Cardiac surgery clinic at the University hospital of Zurich. He has been invited to clinics and universities in Germany, China, and Myanmar. He is an Honorary Doctor of the Pavlov First Saint Petersburg State Medical University and Professor of the Department of Neonatal Surgery and Cardiac Pathologies of Newborn and Premature Children of the State Medical Pediatric University, St. Petersburg, Russia.
Information about the foundation
The humanitarian medical organization EurAsia Heart was founded in 2006 in Zurich. Leading cardiac surgeons in Europe, under the leadership of Professor Paul Vogt, joined forces to train colleagues from the countries of Eurasia in the field of cardiology and cardiovascular surgery. EurAsia Heart operates in Russia, Uzbekistan, Myanmar, Cambodia, China, Vietnam, Eritrea, Armenia, Bulgaria, etc.
The international group of experts at EurAsia Heart consists of, among others, specialists from Yale University, the University Clinic of Vienna, the German Children’s Center of St. Augustine, the Children’s University Clinic Zurich, and the University Hospital Zurich, Switzerland. EurAsia Heart’s trusteeship committee includes businessmen, entrepreneurs and doctors. The ex-President of Switzerland Dr. Adolf Ogi and the former German Chancellor Gerhard Schroeder are coPresidents of the Patronage Committee.
The activities of the Heart of Eurasia are monitored by the Swiss Interior Ministry and supported by the Swiss Agency for International Cooperation and Development (DEZA). In 2019, the foundation underwent certification for a Zewo seal, which means that the foundation meets the highest standards and procures funds in a fair manner.
Russia is one of the most promising partners of EurAsia Heart. For twelve years EurAsia Heart has been active in St. Petersburg, Novosibirsk, Penza, Petrozavodsk, Tomsk, Yaroslavl and Voronezh. Support from the president and the government, implemented in the national Russian project “Health” in conjunction with the international educational and scientific activities of EurAsia Heart, could bring Russian federal centers of cardiovascular surgery to a world-class level.
CH‑8038 Zürich, Switzerland
Tel. +41 44 209 25 14
HOW TO HELP
Donation account: EurAsia Heart Foundation – A Swiss Medical Foundation
Bank: St. Gallen Kantonalbank AG
9001 St. Gallen
IBAN: CH92 0078 1509 1392 0020 1
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