– Assoc. Prof. Chilingirova, what is the thing that motivates you, given the weight of your profession and specialty?

– Patient focus is our main driver in the fight against cancer. Our goal is a personal approach to everyone and the opportunity for the patient to comment in detail on all aspects of their disease with us, the specialists at the , Heart and Brain’ Oncology Centre. Hearing the diagnosis of cancer is like entering another world – full of new terminology and overwhelming decisions. That’s why we doctors are united around a very special mission: to stop the progression of cancer and give our patients a good quality of life. In addition to removing barriers in doctor-patient communication, the goal is to encourage the patient to trust the doctor, to ask questions in order to be informed and to make decisions. Trust is built when we, as professionals, have the courage to say all that matters in an individualized therapeutic approach and take responsibility for our actions. We insist on transparency and know that open and honest communication is critical to therapeutic success.

– How do you achieve complexity in cancer patient care?

– In medicine, and especially in oncology, treatment complexity is key. At the , Heart and Brain Cancer Center, we approach everything we do as one organism. We apply advanced and proven technologies – working in sync and in collaboration with all clinics and departments to provide the best health care and patient empathy. In the radiotherapy department, as indicated, patients can be treated with the unique Gamma Knife, and minimally invasive surgical interventions with the da Vinci robot are part of routine practice. As cancer is now also defined as a disease of the genome, precise diagnosis – based on a range of specific genetic tests – is the cornerstone of successful treatment. That’s why we invest in a highly specialized, certified to the highest modern standards and one-of-a-kind genetics laboratory. At our clinical research centre, patients get much-needed fast access to the latest innovative drug treatments as well as the latest clinical trials in oncology.

The Oncology Centre in , Heart and Brain Pleven is the first in Bulgaria to be a member of OECI (Organisation of European Cancer Institutes), therefore the comprehensive care and access to innovations at every stage of diagnosis, treatment and follow-up has established us as a centre for highly specialised and advanced care.

– What is the place of innovation?

– Innovativeness is about the challenge – constantly learning and getting better. We create and boldly apply new thinking that is valued by patients and colleagues across the country and Europe. We embrace discovery and innovation, knowing that exploring the unknown is the best way to drive progress in cancer treatment and care. We attract, develop and retain specialists who have the curiosity, passion and drive to continuously learn and challenge themselves in the search for a better approach to better outcomes for our patients. Our oncologists participate in a number of international forums as well as international research and clinical projects. They collaborate with colleagues from around the world and put into practice groundbreaking discoveries, even in our understanding of cancer as a disease. And this improves the possibilities for prevention, diagnosis and treatment.

Although the Cancer Centre is one of the youngest in the country, in just the last two years it has managed to establish itself as one of the leading centres and has already gained international recognition.

Patients from all over the country seek help at the Orthopaedics and Traumatology Clinic in ‘Heart and Brain’ Pleven because of the outstanding professionalism of the team, the high-tech equipment and the application of the most advanced world standards

Patients from all over the country seek help at the Clinic of Orthopaedics and Traumatology in ‘Heart and Brain’ Pleven because of the outstanding professionalism of the team, the high-tech equipment and the application of the most advanced world standards in the field of endoprosthetics and revision orthopaedic practice. Only for the first six months of the year 1410 patients have undergone treatment at the clinic. The first place is hip, knee and shoulder joint arthroplasty. A total of 564 surgeries were performed, with 335 primary minimally invasive hip arthroplasties alone, and a total of 521 primary hip arthroplasties.

“Endoprosthetics is a highly specialised activity that requires, first of all, an experienced team that applies innovative surgical techniques and young doctors who continuously improve their skills in prestigious courses at home and abroad,” informed Prof. Khan. Prof. Asparuhov.

The main reasons for the need for arthroplasty are arthroses and aseptic necroses, of which Covid 19 is a consequence, as well as hip and shoulder fractures.

Applying innovative techniques with highly specialised instrumentation ensures the long-term durability of the joint and is much kinder to patients, providing absolute stability immediately after surgery, with patients back on their feet just a few hours after surgery.

The number of revision hip and knee arthroplasties is also growing. According to prof. Asparuhov, the clinic in ‘Heart and Brain’ Pleven is now a centre for revision arthroplasty, thanks to the excellent conditions the hospital provides for this. The patients are mostly elderly, with many concomitant diseases that require constant – operative and resuscitation care.
Outpatient activity is also extremely busy. In the first six months of the year alone, nearly 7,730 patients passed through the consulting rooms. Emergency trauma registrations are also increasing due to the fact that patients themselves seek help directly at Heart and Brain because of the clinic’s reputation and credibility.

The founder of the “Röttinger approach” consults and operates in Bulgaria

Who is doctor Heinz Röttinger?
During my professional career I have always been interested in orthopaedics with all its aspects and specific fields. Particularly important to me is the field of arthroplasty, i.e. the artificial replacement of large joints such as the hip and knee. Over the years I have gained a lot of experience and knowledge that has earned me high praise and respect worldwide. Today, my name is usually mentioned when talking about sparing and minimally invasive surgeries and artificial joints. I have also been involved in the development of highly successful knee implants. I have been called a “pioneer” in the field of minimally invasive arthroplasty.

Why did you choose ‘Heart and Brain’?
For many years I have been in friendly contact with many Bulgarian colleagues at Heart and Brain, I have often visited them and we have worked together. I have always appreciated their professional discussions, well-reasoned positions and advanced knowledge. When the high-tech hospital complexes in Pleven, and later in Burgas, started operation, I was very impressed by the high standard of the technical equipment. The increasingly intensive exchange of knowledge and experience in our common work required me to travel to Bulgaria more and more often. And this developed into a long-term process of combining practical with scientific activities in your country. It is a pleasure to operate together with the surgeons at Heart and Brain and I am proud to be able to pass on my experience to the new Bulgarian medical generation.

What is the professional level of the teams you work with in Bulgaria?
I would describe my colleagues at Heart and Brain as absolute professionals. They have a lot of experience and a solid academic background. In addition, I notice a great interest and willingness to learn new knowledge and skills. The demand for continuous individual and team improvement is much more pronounced in Pleven and Burgas than in Germany. This intrinsic motivation also corresponds to my attitude towards the profession. Patients can wish for nothing better than a doctor who is always striving to improve.

What makes you feel so useful in our country and what short and long-term goals have you set for yourself?
I have the full support of the management teams and the freedom to pursue multiple short and long term goals. A particular focus is the training of young doctors in , Heart and Brain’ to whom I want to pass on all my experience. I love scientific discussions and enjoy demonstrating advanced surgical techniques. When you have achieved almost everything in the profession, it is a pleasure to initiate and observe the positive individual development of young colleagues. Therefore, I see the short-term goal as continuous quality improvement, and the long-term goal, of course, is for as many doctors as possible to reach a high professional level and take responsibility as team leaders. Achieving this long-term goal would make me extremely happy.

You are planning to develop a joint transplant centre in Burgas. Please tell us more.
My name, of course, is closely linked to the field of arthroplasty. In this regard, I am extremely focused on expanding the range of services in Burgas, and in particular joint retransplantations. Over time, a replacement joint can wear out or loosen, so one or more components may need to be replaced. And the benefits are many – reducing pain and stiffness, increasing range of motion and improving overall quality of life. I want to establish state-of-the-art medicine in Bulgaria according to international standards.

What impresses you in your contacts with Bulgarian patients?
Both in Bulgaria and in Germany, every upcoming surgery is associated with some anxiety and this is completely normal. Most orthopaedic interventions do not secure vital organ functions, i.e. they are not performed on an emergency basis. Therefore, patients often postpone them in time – they decide that they can live with some pain or physical limitations. However, it has been proven that the right orthopaedic surgery can provide a much better quality of life. For this, patients need to consult with an experienced specialist with proven expertise who can suggest the appropriate primary or revision surgery.
Rehabilitation is also important. In order to shorten the period of limited mobility, we apply conservative (non-operative) treatment before surgery when appropriate. At ‘Heart and Brain’ patients receive rehabilitation with an individual treatment plan – after musculoskeletal surgery this process is key.

How do you see the future of orthopaedics?
The future of orthopaedics will be heavily influenced by how state-of-the-art technology can be integrated into treatment. This applies to orthopaedics in general, but also to arthroplasty in particular. Diagnosis will continue to improve significantly. Simulations will be used to determine and plan the optimal personalized treatment for the patient. Top-of-the-line technologies will then be used to implement treatment on schedule. Here, for example, I am talking about robotics of a completely new generation. To date, available technologies can often only duplicate what any experienced physician can do without a robot. But we can analyse the available information and model the different treatment options using simulation. In recent years, I have done a lot of research into these analyses and simulations.

The team is part of the only gynaecology department in the country equipped with the latest generation equipment for robotic, hysteroscopic, conventional and 3D laparoscopic surgery

The ‘Mama and I’ clinic, part of the high-tech ‘Heart and Brain’ hospital complex, now has the latest generation system for performing minimally invasive laparoscopic surgeries. The technology provides the highest image quality with 4K resolution, simultaneous 3D picture and the possibility to use infrared filters to visualize the fluorescent dye indocyanine green (ICG). The clinic team is the only one in Bulgaria with the complete Rubina system and has the knowledge and skills to use it to its full potential.

“It can be said that we are pioneers in introducing this state-of-the-art treatment into surgical practice in our country. The technical capabilities are at a level never known before – every detail, even the tiniest, can be seen quite clearly and in three dimensions, which greatly improves the perception of the surgical space. The detailed visualization of the anatomical structures, especially when they are pathologically altered by various diseases, allows even more precise performance of operations”, says Dr. Alexander Lyubenov, Head of the Department of General and Oncological Gynecology, who has already performed the first operation with the new system.

“And for us, the specialists, the benefits of the new technologies are many – the image is of the highest quality and thanks to the 3D image, the feeling is that you literally sink into the deep spaces of pelvic surgery,” says Dr. Lyubenov.

The Rubina system is extremely suitable for complex and interdisciplinary surgical interventions, such as those often required in oncological diseases, severe endometriosis, prolapse of the female genital organs using flaps or natural tissue, as well as in reproductive surgery. The fluorescence technology built into the system allows the detection of lymph nodes in oncological diseases, as well as the assessment of the blood supply to the bowel in resections in abdominal surgery – methods that have established themselves as the gold standard in leading clinics in Western Europe and the USA. The new system ensures safer and more precise performance of complex gynaecological, urological and surgical interventions, providing even better and higher quality treatment for patients.

The Heart and Brain Neurology Clinic team, led by Prof. Plamen Bozhinov, MD, presented the outstanding success of non-invasive brain stimulation in stroke patients at the 10th Congress of the European Academy of Neurology (EAN). The event took place in the capital of Finland from 29 June to 2 July 2024. As one of the pioneers in the field of therapeutic neurophysiology in the country, Prof. Bozhinov and his team demonstrated the results of applying the method in their clinical practice.

“I am extremely proud of the results achieved in Pleven. Repetitive Transcranial Magnetic Stimulation (rTMS) is indispensable in the early rehabilitation of patients who have suffered strokes, in the treatment of various pain syndromes, Parkinson’s disease, Alzheimer’s disease, neuro-psychiatric development disorders in autism spectrum disorders, etc.,” says Prof. Bozhinov. It is no coincidence that the main topic of the congress was non-invasive brain stimulation in various neurological diseases. Modern neurological science is increasingly moving towards the use of various devices for such stimulation. This does not contradict drug therapy, but in most cases complements it. In pTMS we direct repetitive magnetic pulses at specific intervals to specific areas of the brain. These pulses reach brain cells, stimulate them and improve communication between different parts of the brain. Our experience in applying this therapeutic method includes monitoring more than 1,500 patients with a wide range of neurological and psychiatric diseases, including about 200 stroke patients,” adds Prof. Bozhinov.

During the congress, Dr. Stoyan Bozhinov, a neurology resident, presented results of EEG follow-up of the effect of rTMS in early rehabilitation of patients who have had strokes, and Polya Lambeva, a master’s student in medical rehabilitation and occupational therapy, presented the experience of the nervous diseases clinic related to the effect of non-invasive brain stimulation in patients with Parkinson’s disease.

The attention of the audience was also drawn to EEG (electroencephalographic) monitoring of patients with impaired consciousness in the ICU or intensive care unit setting. Great progress has been made in this area, with strictly defined EEG markers concerning good or poor clinical prognosis being identified.

“In , Heart and Brain’ EEG monitoring of patients with disorders of consciousness has been routinely used in clinical practice for about 3 years. Together with Dr. Vladislav Genov, Head of the Department of Anaesthesiology and Intensive Care, we have a great deal of clinical experience involving the monitoring of comatose patients of various backgrounds. Also of interest are the reports on the treatment of neurological diseases during pregnancy, the administration of different types of medications in pregnant women with epilepsy, and the management of possible complications of eclampsia (seizures). Together with the team of Assoc. Yordan Popov, Head of the Clinic of Obstetrics and Gynaecology at ‘Heart and Brain’, we have unique for our country practical experience in the follow-up and treatment of pregnant women with all neurological diseases”, summarized prof. Bozhinov.

“The European Academy of Neurology gives the continent’s leading specialists the opportunity to ‘check their watches’ with all the latest advances in neurological science and practice. In this way, we can be of maximum use to our patients and our colleagues in solving complex and difficult to diagnose and treat clinical cases, bordering between different medical specialties,” the neurologists concluded.

The procedures are performed by a urologist after a preliminary assessment of hormonal status by an endocrinologist 

A joint team of urologists and endocrinologists applies procedures with the latest generation shock wave therapy device. This is a non-medication and non-operative treatment that complements the complex therapy for erectile dysfunction, chronic prostatitis, Peyronie’s disease and gives excellent results, informs Dr. Silvia Ganeva, head of the department of endocrinology and metabolic diseases at the high-tech hospital.

The procedures are performed by a urologist after a preliminary assessment of the hormonal status by an endocrinology specialist.

“In shock wave therapy, painless pneumatic pulses are generated by the device and directed to the tissues. This achieves a number of positive effects, such as improving blood supply with anti-inflammatory effect, enhancing recovery processes and innervation,” explains Dr. Georgi Ivanov, a specialist in the urology department.

The procedure takes between 10 and 15 minutes depending on the area treated and the disease. The complete therapeutic course includes 6 to 8 treatments once or twice a week. With shockwave therapy, the need for and cost of medication is reduced. The method is scientifically proven to be highly effective, with high patient satisfaction with its application and lasting benefits for patients.
Treatments are paid for, with prices included in the hospital’s basic price list.

The observations of the specialists at ‘Heart and Brain’ indicate that erectile dysfunction is an increasingly common problem among men of active age. Worldwide, it is estimated that 10% of men between 40 and 70 years have a complete loss of erection. Partial loss of erection is experienced by 30-40% of men in this age range, with the incidence of the disorder increasing to 70% in men over 70. Many factors are thought to cause erectile dysfunction, with half of patients having organic causes brought on by chronic diseases such as arterial hypertension and diabetes mellitus. Frequently used antihypertensive, lipid-lowering medications and antidepressants can also exacerbate the problem.

Chronic prostatitis is an inflammation of the prostate gland that is recurrent. A significant percentage of cases are due to bacterial infection, most commonly caused by Escherichia coli. It is estimated that more than 8 million people worldwide consult a urologist for complaints of chronic prostatitis, and between 2 and 16% of men have manifestations of the disease at some point in their lives, Dr Ivanov says.

On June 17, 2024, a 56-year-old man was admitted to the Vascular Surgery Clinic of ‘Heart and Brain’ Burgas, in an impaired and unstable general condition, with sudden onset of severe abdominal and lower back pain and increased pulsations around the umbilicus. The patient had a known, established history of abdominal aortic aneurysm, as well as a number of co-morbidities such as diabetes mellitus, hypertension, cerebrovascular disease, and a malignant bladder neoplasm. All these factors make the medical case a challenge of increased difficulty for vascular surgeons and put the patient’s life at risk.

After extensive blood and imaging studies, including an abdominal organ scan, and the primary diagnosis of abdominal aortic aneurysm was confirmed, the patient was prepared for emergency surgery. It involved not only the abdominal aorta but also the overlying renal arteries bilaterally. The multidisciplinary team of surgeons was formed during the peri-procedural preparation – not only to give the patient the best chance of survival, but also to ensure a better quality of life going forward, especially given the young age at which the man was diagnosed with this rare but severe pathology. […]

The full article is available here in Bulgarian.

Neonatology department is a trademark for quality care

“To Dr. Hristov. Thank you for helping Radi! From Marina.” This short but loving message touched the neonatologists at Mama and I’ in Pleven. Eight-year-old Marina has found her own way to thank the rescuers of her baby brother, Radi, who was admitted to the intensive care unit with severe polyorgan failure from another small hospital in Northwest Bulgaria.

Currently, the neonatology ward of the only maternal and child health clinic of its kind ‘ Mama and I’ is overflowing with young patients. There are 21 children in intensive care alone. They are newborns from all over Northern Bulgaria who need observation, instrumental monitoring and intensive treatment. A team from the ward is ready at any moment to take the special resuscitation vehicle, equipped with a transport couch with respirator, to the next newborn child at risk, in the North East or North West, to be transported to our ward in time. With these words we are greeted by Dr. Andrey Hristov, head of the neonatology department.

You can read the full interview is available here in Bulgarian.

At a solemn ceremony yesterday the Governor of Burgas and patron of the competition, prof. Maria Neykova, the Burgas District Governor and patron of the ceremony, awarded the prize “Personality of the Year 2023”. The big winner is Assoc. Prof. Vladimir Kornovski – leading cardiac surgeon and medical director of the high-tech hospital ‘Heart and Brain’.

Dr. Vladimir Kornovski – the world-class cardiac surgeon who chose the newly built ‘Heart and Brain’ hospital in Burgas over Switzerland and every other cardiac surgery center in the world to save our hearts, won the prestigious award. It received a record 34,826 votes or 55.64% of the people’s approval in all editions of the competition so far.

Traditionally, nominations are made by the public – citizens, institutions, NGOs and initiative committees. Already at the end of the first stage, in January 2024, the organizers announced a record result for the entire history of the contest – 34 826 votes or an impressive 55.64% of all votes.

His patients and colleagues describe him as a dedicated and humble professional who always puts the well-being of the people in his care first. The record number of complex cardiac surgeries performed by him or under his direction in the past year has also brought widespread recognition to the hospital’s teams. To the young doctors, he always encouragingly repeats, “Our knowledge and skills save lives every day”!

In his acceptance speech, Assoc. Kornovski remained true to himself:

“I am touched by this honor and the way the community responded to the nomination submitted by my patients. I think this is a real precedent that shows that kindness, cordiality, respect remain timeless!

The specificity of my profession – to serve the people – obliges me to continue to develop and learn, to prepare and train the young doctors of Burgas and create conditions for teamwork, mutual respect and most of all – humanity in relations with patients.

I am grateful to my family and to ‘Heart and Brain’ – my workplace, where there are all conditions for the development of modern medicine and high technology, freedom of choice of therapeutic solutions and striving for innovation in every step of the healing process. Because I am here today, thanks to all these people!”

Patient initially underwent surgery for cervical cancer and underwent radiotherapy

The urology specialists at ‘Heart and Brain’ Burgas performed a unique and first-of-its-kind surgery for the region. The complex surgical intervention to build a new ureter from the small intestine of a patient whose left ureter had been damaged in a previous cancer surgery was successful. The fifty-six-year-old woman initially underwent surgery for cervical cancer and underwent radiation treatment. Disturbing changes prompted her to contact doctors at the high-tech hospital complex. They conducted imaging tests and found a connection between her left ureter and vagina.

“This clinical case is extremely challenging due to the fact that about half of the ureter was damaged as a result of the previous surgery and subsequent radiotherapy. In order to restore normal urine output, a new ureter had to be constructed from a thin-walled segment,” says Dr. Statelov, head of the urology department and part of the operating team.

Thanks to the excellent professional training and multidisciplinary approach that the medics of ‘Heart and Brain’ Burgas can guarantee to the patients, this complex case is another successfully solved health case in Burgas.