Below, we introduce Matjaž Bunc, a cardiologist from the Department of Cardiology at the University Medical Centre Ljubljana (UMC) who a few days ago conducted a procedure regarded as one of the highest achievements in contemporary cardiology.
INTERVIEW WITH MATJAŽ BUNC
An internist specialised in cardiology. Working at the UMC in Ljubljana. Further specialised in interventional cardiology. Participant in the programme of treatment of progressive heart failure.
He holds double professorship at the Faculty of Medicine: he is an associate professor of Pathophysiology and Internal Medicine. He is respected by his students for his ability to deliver his subjects in a clear and concise manner and the ability of interconnecting and understanding the interdependence of various fields.
He is an excellent diagnostician and practitioner. Researcher, sportsman and father, he is a man with a view of the future and a heart in the service of people. At 40 years of age, he is the protagonist of the implementation of a new procedure for treatment of aortic valve stenosis.
More about Dr. Bunc’s professional career …
VB: What is your primary personal focus?
MB: I am interested in the mechanisms of problems and the logic of treating them: medicamental therapy, reviewing insufficiently explored mechanisms of treating illnesses, new approaches to treatment of illnesses that have been familiar for a long time, e.g. aortic valve stenosis, etc. I believe in a comprehensive, holistic approach in medicine, therefore I do not limit myself to cardiology in my research work. I cooperate with other specialists, both in planning of the research and in assessment of the results.
VB: Please describe the importance of the achievement of a few days ago at the Clinical Department of Cardiology at the UMC.
MB: We implemented the first percutaneous implantation of an aortic valve. This means that patients with aortic valve stenosis who cannot be subjected to the classical surgical procedure now have the possibility of implantation of aortic valve prosthesis.
VB: This is one of the key achievements in modern cardiology. How did you achieve this important breakthrough?
MB: After the first successful implantation procedure performed in 2002 in France and the official presentation of the first five patients in 2004, we started to follow the development of the method systematically. Initially, it was tested in selected research centres around the world and in January 2007 the method was first transferred to commercial centres around Europe which had to satisfy very strict criteria. Out of 100 interested European centres we were selected as one of the first six commercial centres to implement what had previously been only a study method. This was followed by a period of fulfilling formal requirements in the local environment (approvals by the ethical committee, various expert groups and the UMC’s Expert Council). Simultaneously, we performed the appropriate training and prepared the logistics for commencement of the programme. The team at the UMC was prepared for the first implantation in August 2008, but commencement of the project was postponed until 2009 due to procedural reasons.
VB: How did you transmit the information to the interested patients?
MB: Earlier this year, we started informing various medical institutions about the process of implementing the method. Simultaneously, we performed a selection of suitable patients according to very strict criteria. The conditions of some of the patients did not allow waiting for the foreseen implantation; therefore we revived the method of treating the aortic valve with balloon dilatation. According to years of experience, this method provides a temporary improvement which is in most cases sufficient for the patients to wait for the suitable more effective treatment.
VB: Was the selection of patients left to you or are there other, external controls?
MB: In these initial stages of implementing the method we are cooperating with the manufacturer of the valve in selecting the patients, primarily to ensure their safety but also to allow ourselves the time to build up the necessary confidence. The manufacturer performs the final assessment of the suitability of the method for the proposed patients. They also perform additional control in the procedure implementation phase through the presence an instructor (proctor) who supervises the entire process during the first few implantations.
Implantation of the valve prosthesis with the simplified procedure of inserting it through the blood vessel has already been performed on 6000 patients across the globe. Based on the positive results, the procedure is increasingly being implemented in the daily cardiologic practice.
VB: Your case is an example of implementing an important innovation into the surgical practice. Who is it for?
MB: At the current levels of technology and treatment techniques the method is intended for patients with aortic valve stenosis who are not suitable for the surgical procedure. Primarily, these are older patients.
VB: What is the value of your procedure for the patients?
MB: Many of them can enjoy the improved quality of life with less frequent occurrences of fainting, dizziness, suffocation and other symptoms of heart failure. They regain greater independence from their social environments. In other words, they can live full and independent lives. The procedure is also less traumatic (than surgery) for the patient as it does not involve opening the chest, which is necessary with the classical surgical procedure. Rehabilitation is shorter and they regain independence more quickly.
VB: What are the effects on the business models of hospitals?
MB: This procedure is significant for health insurance providers and hospital management. Patients entering this process of treatment formerly used to return to clinical wards due to recurrence of symptoms mentioned earlier. The procedure will make their treatment more effective, their rehabilitation shorter and enable them quicker return to their social environments.
VB: Who are the members of your team?
MB: The primary method covers both interventional cardiology and heart surgery. Thus, the preparation and implementation of such procedures requires a high degree of cooperation, exchange of knowledge and coordination between various specialists. This is one of the qualities of our team. After some initial problems we managed to find a common goal and successfully implemented the procedure in Slovenia.
VB: The valve prosthesis and the procedure of implantation are an example of innovation in medicine. How do they influence the professional field today and how will they influence the future?
MB: This is an excellent example of integration of two fields. The result is a process of developing hybrid approaches to treatment of cardiovascular illnesses. The relevant method also requires new technical solutions leading to a hybrid operating room. Simultaneously with the technological development, indications for hybrid surgical procedures are being implemented with the aim of achieving the best medical results with the least traumatic procedures. In short, this innovation has and will significantly influence the development of our expert field.
VB: Which way forward?
MB: The development of technology is directed towards developing miniature technical solutions, appropriate for a wider range of patients and ensuring minimisation of complications due to surgical procedures. The technical development also enables the development of procedures performed through blood vessels, which means we can avoid surgical procedures and reduce the need for anaesthesia and shorten the time needed for rehabilitation.
VB: And what is the future focus of Dr. Matjaž Bunc?
MB: To seek solutions which help the patient and the health care system by providing more efficient and more patient-friendly treatment. I hope this will not be the last new method my colleagues and I implement in Slovenia. We are also investing great efforts in the development of procedures, thus expanding the global knowledge and experience base in the field of medicine, in my case – in cardiology.
Medicine is one of the fields where the boundaries of the possible are constantly expanded and where the comprehensive approach to patients opens up new procedures and solutions. The strict borders between the different specialist fields are disappearing and procedures and approaches are being adjusted and upgraded. Doctors increasingly cooperate with patients, use new technologies, and by effectively merging needs, possibilities and opportunities create innovations where they are most needed – in effective solutions for patients. Slovenia is at the global forefront, both in the development of these procedures and in their implementation. We are hoping for more similar stories.
The interview was conducted by Violeta Bulc at the beginning of July 2009.