Cardiocerebrovascular Hospital, Seoul St. Mary’s Hospital, Catholic University of Korea
4 clinical centers – 1 hybrid center… Synergy of 24-hour collaboration between internal medicine and surgery
10th birthday this year… Cooperating hospitals and clinics triple ↑
Accumulation of patient data, strengths in customized treatment… Jang Ki-yuk Hospital Director Tabi’s first record
Seoul St. Mary’s Hospital opened the Cardiovascular Center in 2014. This is because as the elderly population increases, the number of people with cardiovascular diseases is increasing. The hospital decided that active measures were needed to prevent and treat this disease, and the result was the specialized center.
Five years later, in 2019, Seoul St. Mary’s Hospital expanded and reorganized this center into a cardiovascular and cerebrovascular hospital. Meanwhile, the number of people with cardiovascular disease increased faster. The hospital’s response also changed to be more active accordingly. The organization was raised to the level of an independent, large-scale hospital.
This is the 10th year that Seoul St. Mary’s Hospital has been operating as a specialized organization for cardiovascular and cerebrovascular diseases. There have been many changes in the meantime. I listened to Jang Ki-yook, director of the Cardiovascular Hospital at Seoul St. Mary’s Hospital (professor of circulatory medicine), about his story over the past 10 years. Professor Jang took office as the director of the Cardiovascular Hospital in 2021, and two years later, he entered his second term in September of last year.
● Establishment of a collaboration system between internal medicine and surgery
In the case of heart disease, there are often differences of opinion among doctors about whether to perform a medical procedure or a surgical procedure. Hospital Director Jang said, “After upgrading to a cardiovascular hospital, communication between internal medicine and surgeons became more active, and such controversies and conflicts disappeared.”
This means that cooperation is going well, but in reality, there are many cases like this. It was a while ago. Mr. A, a man in his early 80s, went to a nearby hospital in the middle of the night because of severe stomach pain. As a result of a computed tomography (CT) test, it was confirmed that the abdominal aortic aneurysm was ruptured. Mr. A went to Seoul St. Mary’s Hospital by ambulance.
Mr. A also had severe coronary artery calcification. There was a possibility of angina pectoris. In this case, if surgery is performed recklessly, a serious situation may occur. Mr. A’s situation was immediately shared in the group chat room of doctors at the Cardiovascular Hospital. In a group chat room, professors discussed treatments. As a result, the cardiologist first performed coronary angiography (cardiovascular angiography) to check for heart abnormalities such as angina pectoris. Fortunately, there were no major problems. A vascular surgery professor was immediately brought in and continued the abdominal aortic aneurysm surgery. Mr. A’s emergency surgery was completed successfully.
Hospital Director Jang said, “There are times when it is determined that surgical operation is necessary during internal medicine treatment. In this case, the doctors immediately communicate with each other and decide whether to perform surgery. “Doctors at the Cardiovascular and Cerebrovascular Hospital communicate 24 hours a day via phone or group chat room,” he said. Through this communication and discussion, it is decided whether to perform a procedure, whether to perform surgery, or whether to perform a combination of surgical and medical procedures.
● Strengths in Tabi treatment
![“Tavi treatment is easy for high-risk patients… There are also many first records.”[베스트 메디컬 센터]](https://dimg.donga.com/wps/NEWS/IMAGE/2024/10/26/130298296.1.jpg "“Tavi treatment is easy for high-risk patients… There are also many first records.”[베스트 메디컬 센터]")
The Cardiocerebrovascular Hospital of Seoul St. Mary’s Hospital is also famous for its TAVI (transcatheter aortic valve replacement) procedure, one of the treatments for aortic valve stenosis. Hospital Director Jang has also performed more than 1,100 Tabi procedures to date.
Valves are the doors of the heart. When the heart pumps blood, the valves close. As we age, these valves can harden. A typical example is aortic valve stenosis, which is located between the left ventricle of the heart and the aorta. When this happens, blood cannot flow from the heart to the aorta. Symptoms such as shortness of breath, chest pain, and fainting appear. If this level of symptoms appears, it should already be considered severe. If not treated quickly, there is a high risk of death within two years.
The Tabi procedure is a treatment that replaces a damaged valve by inserting an artificial valve through the femoral artery in the thigh without opening the chest. It is mainly performed on patients over 70 years of age or patients at high surgical risk.
Seoul St. Mary’s Cardiovascular Hospital has many strengths when it comes to Tabi procedures. Hospital Director Jang especially emphasized the good results of Tabi treatment in so-called high-risk patients, such as those with other diseases or the elderly. For example, the case of 89-year-old grandfather B is representative. Grandpa B received outpatient treatment and suffered from severe angina. Three stents were inserted into the coronary arteries. Thanks to this, the chest pain disappeared, but the shortness of breath did not go away. The aortic valve stenosis was severe. An artificial valve had to be inserted into the femoral artery, but the patient suffered from peripheral artery occlusion, in which the blood vessel was significantly narrowed. Director Jang dilated the narrowed right leg artery with a stent and balloon and then inserted an artificial valve.
Grandpa B’s kidneys were also in poor condition. For this reason, angina, peripheral artery occlusion, and aortic valve stenosis were treated step by step over 5 days. The results were good. Grandpa B soon went to the general hospital room. Hospital Director Jang said, “For patients at high risk of stroke, we perform valve surgery while preventing stroke using a device called Sentinel.”
There are also many first records. In 2022, Hospital Director Jang successfully performed the Tabi procedure on a patient with both femoral arteries blocked. The tabi valve was inserted through the axillary artery instead of the femoral artery. This was the first procedure attempted in Korea.
There are patients who have had an artificial valve implanted but it becomes narrow again. In this case, another Tabi procedure is needed. However, depending on the patient, the procedure may be difficult because the height does not match the coronary artery. If the procedure is performed as is, the coronary artery may become blocked. Therefore, a valve must be inserted to prevent coronary artery blockage, which is called the ‘Basilica procedure.’ In 2023, Hospital Director Jang successfully performed the basilica procedure for the first time in Korea.
Another advantage is that the Tabi procedure is performed using only local anesthesia. Most hospitals use a combination of general anesthesia and local anesthesia. However, in the case of Seoul St. Mary’s Hospital Cardiovascular Hospital, 100% local anesthesia is used. Also, rather than piercing both femoral arteries in both legs, only one artery is pierced. Thanks to this, you can walk about 6 hours after the procedure and can be discharged a day or two later.
The Cardiocerebrovascular Hospital of Seoul St. Mary’s Hospital uses four different types of valves that have been introduced into Korea, each tailored to the patient. Hospital Director Jang boasted, “If the safety of valves was an issue in the past, now the key is how long they can be used reliably. We have accumulated patient data for 10 years, so we can provide customized procedures to patients.” .
The Heart and Cerebrovascular Hospital of Seoul St. Mary’s Hospital also obtained ‘supervision’ status designated by the Tabi manufacturing company. This is a qualification that can be provided to doctors seeking Tabi training in the Asia and Pacific region.
● Strengthening cooperation with local hospitals
Hospital Director Jang said that the role of Seoul St. Mary’s Cardiovascular and Cerebrovascular Hospital is to solve problems that small hospitals and clinics cannot solve. To this end, Hospital Director Jang increased the number of partner hospitals and clinics. As a result, the number of hospitals and clinics directly collaborating with Seoul St. Mary’s Hospital Cardiovascular and Cerebrovascular Hospital tripled from about 50 to about 150.
Hospital Director Jang said, “When it comes to cardiovascular and cerebrovascular diseases, time is everything. There are many emergency situations. “If the problem cannot be resolved at a local hospital, the patient must be immediately transferred to a larger hospital to save the patient’s life,” he said. “To this end, if an emergency patient occurs, especially in Seoul, Gyeonggi and South Chungcheong regions, we have established a system that allows them to be transferred to the Cardiovascular and Cerebrovascular Hospital of Seoul St. Mary’s Hospital at any time.” “We built a system,” he said. Through this, we aim to provide medical services to local patients. However, recently, due to a shortage of residents, only professors are on duty, so this system has been temporarily suspended at night.
Seoul St. Mary’s Cardiovascular and Cerebrovascular Hospital has been participating in the ‘Severe Emergency Cardiovascular and Cerebrovascular Care Network Pilot Project’ hosted by the Ministry of Health and Welfare since early this year. Hospital Director Jang said, “The Cardiovascular Hospital has a system that allows diagnosis and treatment to be completed within 30 minutes when a patient arrives at the hospital. “For this purpose, a specialist is stationed 24 hours a day,” he emphasized.
● How is the Cardiovascular Hospital organized?
The Heart and Cerebrovascular Hospital of Seoul St. Mary’s Hospital consists of four clinical centers, including the Cardiovascular Center, the Cerebrovascular Center, the Aorta Center, and the Vascular Center. Separately, a hybrid surgery center is also operated.
Hybrid surgery is a treatment that takes advantage of both stent insertion, an endovascular treatment, and arterial bypass surgery, a surgical treatment. Heart surgery has the advantage of minimizing skin incisions and short recovery time after surgery.
The Heart and Cerebrovascular Hospital of Seoul St. Mary’s Hospital is the mainstay of the heart and cerebrovascular centers of eight hospitals under the Catholic Medical Center and also serves as a control tower for treating seriously ill patients. We also support research on cardiovascular and cerebrovascular diseases at each hospital.