Until recently, the Bakoulev CCVS was performing up to 30% of all open heart cases in the Russian Federation, almost 60% of pediatric surgery, up to 90% of surgery in neonates with congenital heart disorders. In 1999 the total amount of operations exceeded previous years’ result by ca. 40%. In 2002 the Center performed almost 6000 operations on the heart and great arteries, including 3400 open heart surgeries. Since 2004, the Center is the first in Europe by the number of open heart procedures performed in one hospital (>4200), and if we take into account the Center’s branch in Perm, then it can be considered as world’s leader, too. Moreover, the Center has long been world’s leading institution by the number of surgeries performed for congenital heart diseases. 

Leo A. Bockeria is one of few cardiac surgeons able to perform treatment for most diverse illnesses using the whole range of existing cardiac surgical techniques with the application of heart lung machine. His unique experience of thousands of open heart surgeries puts him on a par with leading Russian and world’s surgeons. 

Most recently Leo A. Bockeria performed fundamentally new operations for obstructive cardiomyopathy, tachyarrhythmia, complicated forms of MI, vasospastic angina, long QT syndrome, for prevention of sudden cardiac death, first successful implantations of artificial left ventricle, first minimally invasive operations. One of Leo A. Bockeria’s key interests of the past years is surgical treatment of congenital heart diseases in neonates and infants of the first year of life. He was the first in Russia to perform a number of unique procedures on the heart with application of newest techniques. 

Leo A. Bockeria pioneered the use of HBO in Russia. He largely contributed to the development of fundamental basis of the method by introduction of the principle of optimal HBO regimen. From the clinical point of view, specific variants of the method were developed allowing its application to patients at high risk of surgery, thus providing for conduction of operations on the “dry” heart, including operations with artificial circulatory support. Original works were carried out devoted to the application of hyperbaric oxygenation in intensive care, transplantation and some other fields. He personally performed more than 200 cardiac operations under high pressure in a specially equipped pressure operating room. A number of “dry” heart procedures, as well as procedures performed with combination of hyperbaric oxygenation and artificial circulatory support were the first in the global surgical practice. 

Leo A. Bockeria belongs to the initiators of the surgical treatment for heart rhythm disturbances – a novel direction in the clinical medicine. In 1980 he founded the first in Russia specialized Department of Tachyarrhythmia and introduced electrophysiological diagnostic methods for heart rhythm disorders. A new complex for noninvasive examination of patients with complex life-threatening rhythm disturbances was developed and introduced into the routine practice of the hospital and included most contemporary diagnostic tools, surface mapping system, high-resolution ECG, heart rhythm variability and others. New techniques for surgical treatment of the syndrome of premature ventricular excitation, supraventricular tachycardias and life-threatening ventricular arrhythmias were developed and put into wide practice. These include operations of resection and innervation of the sinus node combined with implantation of bifocal pacemakers for sinus arrhythmias and long QT syndrome; epicardial electric pulse destruction for Wolff-Parkinson-White syndrome; endocardial resection and cryolysis for non-coronarogenic ventricular tachycardias, long QT syndrome; various operations of atrioventricular node isolation for nodal tachyarrhythmia; radical procedure for elimination of atrial fibrillation; complex operation “Labyrinth-3” for the treatment of atrial fibrillation. Leo A. Bockeria was the first to perform one-stage surgical procedures for congenital, acquired heart diseases, ischemic heart disease combined with life-threatening tachyarrhythmias. These operations greatly expand the opportunities of radical treatment of patients earlier considered to be inoperable. Besides, he was the first in the country to implant cardioverter-defibrillators for sudden death prevention. His experience of open-heart operations for tachyarrhythmias is truly unique and comprises almost 2000 interventions. 

Leo A. Bockeria largely contributed to the problem of ischemic heart disease, which is today one of most widespread cardiovascular diseases. He pioneered the use in the daily practice of new methods of left ventricular reconstruction in patients with cardiac aneurysms after myocardial infarction. This is a new type of physiologic procedures for patients at very high surgical risk. Leo A. Bockeria initiated and pioneered the use of minimally invasive cardiac procedures, including those with the employment of 3D imaging of the surgical field allowing higher safety of the operation. One of major achievements of prof. Bockeria is that in cooperation with physics it became possible to develop, perform for the first time and introduce into routine practice transmyocardial revascularization procedures with the use of own carbon-dioxide laser and later on of excimer laser for the treatment of ischemic patients in the most severe state with distal form of coronary artery lesions, when CABG cannot be performed. Intraoperative conduction of TMLR procedure during CABG became a new step in this newest problem. 

Formation of New Approaches to Surgical Treatment of Critical (Terminal) Heart Failure: A New Chapter in the Russian Cardiac Surgery

The name of Leo A. Bockeria is closely connected to the opening of a new chapter in the Russian cardiac surgery, which can be aptly called as “Formation of new approaches to surgical treatment of critical (terminal) heart failure”. He pioneered the development of dynamic cardiomyoplasty concept for critical heart failure. He personally has performed a considerable number of these operations, being also the first in the world to perform the procedure in children. A special emphasis should be paid to the fact that Leo A. Bockeria was the first in Russia to implant totally implantable artificial hearts, including artificial heart “Novocor”. Successful application of these systems allowed Russia to find itself among 5 leading countries with similar cardiac surgical experience and opened new opportunities for radical treatment of patients previously considered to be incurable. Within last years, Leo A. Bockeria alongside with the application of modern methods of auxiliary circulation and replacement circulation performs orthotopic heart transplantations characterized by world-class long-term results.

Leo A. Bockeria pioneered in Russia the development of a principally new branch of cardiac surgery – the minimally invasive cardiac surgery. He was the first to perform successful operations with the use of most contemporary methods in patients with congenital and acquired heart diseases, life-threatening heart rhythm disorders and ischemic heart disease. 

Leo A. Bockeria has always actively and fruitfully applied experimental method in his professional activity. A whole number of procedures and techniques initially tested in experimental settings were later introduced into clinical practice. These include various remote control procedures in the pressure operating room, electrical isolation of the left atrium, cardiac innervation, modeling of cyanotic and acyanotic heart diseases, etc.. To most modern methods belong cryoablation, fulguration, laser photoablation, which are now widely applied not only in Russia, but also abroad.

 

Leo A. Bockeria actively uses computer methods in the diagnosis, modeling of the pathology of circulatory system, gas exchange, and rhythm disturbances. Different nomograms, schematic maps, tables used in the clinical practice were created. Prof. Bockeria is among the initiators of introduction of an automatized cardiac case recording database, which today contains information on more than 20.000 patients.