Cardiac surgeon Alexander Nikolaevich Lishchuk where was he born. Artificial heart valve that does not harm the blood

The family and friends of six-year-old Vanya Mochenkov from the village of Matveevskoye knew that if he was not immediately fitted with artificial heart valves, he would not live even three years. The operation was performed by cardiac surgeon, Doctor of Medical Sciences, Professor Viktor Alekseevich Ivanov at the Russian Scientific Center for Surgery named after. Petrovsky Russian Academy of Medical Sciences, became unique: not only were two artificial valves sewn into Vanya’s heart, but most importantly, one of them was replaced with a new generation artificial tricuspid prosthesis. This is "Tricardix" - the development of Russian scientists.

Today Vanya calmly goes to school every day, and only annual examinations remind him of his heart defects.

More than a million people die from cardiovascular diseases in Russia every year, 55-60% of deaths are due to vascular diseases, 20-25% due to valve damage. Drug treatment for valve damage is effective only for a while - the drugs constantly stimulate the heart muscle. If the operation is not performed, the patient will have to change his entire life rhythm: serious physical activity and psychological stress will be dangerous for him.

There are two types of artificial valves: mechanical and biological. “Mechanical valves in the world now are primarily bicuspid (bicuspid); biological valves are tricuspid, tricuspid, that is, more similar to valves operating in a healthy heart,” says Doctor of Medical Sciences, Professor Alexander Lishchuk, head of the Department of Cardiac Surgery at the Central Military Clinical Hospital Hospital named after A. A. Vishnevsky - Biological valves are more functional: they are made from tissues of animals, for example pigs, or taken from corpses. The problem is that biological valves are short-lived - they work for 7-10 years, so young patients, of course, Usually they install mechanical valves."

The operation of mechanical prostheses is accompanied by noise, but this is not their main disadvantage. Installation of a mechanical valve causes severe hemolysis - the breakdown of red blood cells, and the patient becomes required to take lifelong anticoagulants - drugs that will reduce the risk of blood clot formation.

Two artificial valves were sewn into Vanya Mochenkov’s heart at once, one of which was a new generation artificial tricuspid prosthesis “Tricardix”

The innovative development of researchers from the Russian specialized company Roscardioinvest - the same Tricardix sewn into Vanya Mochenkov - can change the situation. This prosthesis combines the characteristics of biological and mechanical artificial valves, has already passed clinical trials and may be commercially produced. “This valve works like a natural one,” explains Regina Kevorkova, deputy general director of Roscardioinvest for quality. “There are no elements in the passage hole of the valve, and no breakdown of blood cells is observed, so the risk of blood clots is minimized. This means there is a chance to reduce, and in the future, possibly completely eliminate the patient’s use of anticoagulants.”

But Tricardix is ​​a mechanical prosthesis, its service life is practically unlimited. “We have developed a technology for nanolayer implantation of carbon into the surface of titanium, which is now used as a material for mechanical valve bodies,” says Roscardioinvest CEO Alexander Samkov. “The most biocompatible material today is carbon; accordingly, the more carbon element in any design, the more it is perceived as less alien."

The material of the valve flaps is also technologically advanced - it is pyrolytic carbon. The cuff with which the prosthesis is attached to the heart can be made in two versions - white polyester or carbon fabric. The cuff is universal and allows you to sew the Tricardix valve into the fibrous ring in any position, regardless of the degree of its destruction.

So far, 45 Tricardix valves have been implanted. The first such operation was performed by Academician of the Russian Academy of Medical Sciences L.A. Bockeria in June 2007 at the Scientific Center for Cardiovascular Surgery named after. A. N. Bakuleva. Clinical trials took place in the largest cardiac surgery centers in Moscow: at the Scientific Center for Surgery named after. A. N. Bakulev RAMS, in the Russian Scientific Center for Surgery named after. B.V. Petrovsky RAMS under the leadership of Viktor Ivanov, as well as in the military hospital named after. A. A. Vishnevsky, where Alexander Lishchuk was involved in the implantation of new valves.

Roscardioinvest presented a full size range of tricuspid valves, and this makes it possible to talk about the versatility of the development: the new valve can be introduced into a heart of any size to replace any damaged valve, and therefore into the body of a person of any age and any size.

“The process of the operation to introduce Tricardix is ​​no different from how we operate when using standard bicuspid valves,” says Alexander Lishchuk. “This is a standard operation: we also switched the heart off, removed the worn or damaged valve, and installed it instead valve with three leaflets, sutured - we simply acted with the feeling that a tricuspid valve could improve the patient’s quality of life. In our hospital, the first operation was carried out with the implantation of Tricardix in the aortic position three years ago, then we began to use new valves quite actively." .

But it is too early to talk about successful commercialization of the new technology. Despite the Roscardioinvest company receiving a registration certificate from the Federal Service for Surveillance in Healthcare and Social Development, as well as a separate license for Tricardix, despite the certification of its products, the launch of serial production of tricuspid valves cannot be carried out without financial support. “We planned a production project at Rusnano, managed to pass all stages of the examination, and in 2009 the supervisory board of Rusnano made the final decision to approve the industrial production of tricuspid valves,” recalls Alexander Samkov. “The condition was for investment from Rusnano.” there was a co-investor, in whose role the Moscow Venture Company was ready to act. We were supposed to receive 930 million rubles from Rusnano, 187 million rubles from the Moscow Venture Company. But after Yuri Luzhkov left the post of mayor of Moscow, development in In Moscow, innovative projects where there is intellectual property have been suspended. Accordingly, Rusnano was not able to provide us with financial support."

According to Regina Kevorkova, patents for all types of structures and for all technological methods of implanting Tricardix were received by Roscardioinvest in 2002-2009, and not only in Russia - intellectual property is protected in the USA, Asian countries, and South Africa. In 2009, Ernst & Young estimated the market value of the exclusive rights to develop the valve at RUB 372 million. Today, Chinese and Iranian investors are actively interested in Tricardix. But the management of Roscardioinvest does not yet plan to take the unique technology abroad. “We are not giving up and hope that Tricardix tricuspid valves will be able to reach the level of mass production in Russia. There are already interested investors who may provide us with financial assistance,” concludes Alexander Samkov.

Quite recently, while looking through the news on the website of the Ministry of Defense of the Russian Federation, I noticed a small information note that talked about the awarding of the Order of Friendship to the head of the Center for Cardiac Surgery of the Central Military Clinical Hospital named after. A.A. Vishnevsky Doctor of Medical Sciences, Professor A.N. Lishchuk. Usually such events are covered on a grand scale, but here is a note of a few lines... I was overcome by curiosity and had a desire to find out more about this person... This is how my first acquaintance with Alexander Nikolaevich took place...

Entering the office, I saw a short, youthful, at first glance, completely inconspicuous man: “This is our professor Alexander Nikolaevich,” Mikhail Nikolaevich Frolkin introduced him, escorting me along the unfamiliar hospital corridors. The professor nodded his head in response and, pointing his hand to the sofa, continued the conversation with the visitor, interrupted by our arrival. From their conversation, I understood that one of the relatives of the interlocutor, Alexander Nikolaevich, needed urgent surgery. The professor quietly explained to him about the need for the operation, presented his arguments, without showing a drop of irritation or impatience, and even the timbre of his voice remained unchanged, as if we were talking about an ordinary tooth extraction operation, although I knew for sure that I had come to talk with a famous cardiac surgeon.

While they were talking, I managed to look around. The office to which I was invited turned out to be a small room in which, in addition to Alexander Nikolaevich, there were several other young doctors. Two of them were sitting at their computers and typing something, the rest were looking at the wall behind me. Turning my head in the direction they were looking, I saw several monitors placed in one row. At each of them, as they later explained to me, there was a live broadcast of the operations taking place at that time in the operating rooms, and on the table, between the computers, there was a microphone, through which the professor gave recommendations to the operating doctors. I immediately remembered my operating rooms, and I felt a little uneasy, but I didn’t show it and, without refusing the offered cup of green tea, I sat down opposite my interlocutor, who had already freed up by this time, and prepared to listen to him.

At first, Alexander Nikolaevich was not at all inclined to talk - doctors kept coming in and out to him, resolving their issues, interrupting with his arrival our conversation that had not yet begun, and I was very embarrassed for what I was taking from him his time, scheduled minute by minute. He explained something to them in his own medical language, incomprehensible to me, and then, with undisguised irony, he turned to me:

“I wonder what you will write about me from all this?”

For some reason, his unusual “you” for me did not offend him at all; on the contrary, it somehow immediately made him closer.

“You won’t believe it,” he continued, “in childhood I was terribly afraid of blood, but, as you can see, I became a doctor and not just a doctor - a surgeon. What can you do, we don’t choose our destiny, and it’s not predetermined by us, probably someone needed it that way...”

Alexander Nikolaevich Lishchuk, having graduated from the Saratov Military Medical Faculty, and having become a doctor in the fourth generation of the Lishchuk family, was assigned to the Trans-Baikal Military District to the position of head of the medical center of a tank regiment. It was there that his “baptism of fire” took place - he, then still a 23-year-old young man, had to undergo his first operation, and his first patient was a boy wounded in a fight. Talking about this incident, Alexander Nikolaevich recalls that “there was almost no fear, endurance helped - his hands obediently performed all the necessary manipulations, pulling out from his memory everything that was taught at the institute.”

This incident determined his entire future fate. Therefore, having entered the Military Medical Academy, then still Leningrad, there were no doubts about the definition of specialization - definitely surgery.

In 3 Central Military Clinical Hospital named after. Vishnevsky, in 1991, he became a resident in the department of vascular surgery. And all this time, going up the career ladder, even his trips to internships at the San Francisco Heart Institute and Stanford University (USA) - all this, in his words, “were only stages of improving skills. Everything else is destined from above..."

I dare to disagree with the professor - God-given talent is not everything. For this talent to be useful, you must have willpower, perseverance, patience, and most importantly, the desire to help people. My interlocutor, according to his colleagues, has all this in abundance.

Citing examples from his surgical practice, he constantly repeated that “nothing in this life happens by chance, I am simply fulfilling my assigned purpose, and everything that I know how to do was given to me for a reason, so I have no right to deceive expectations their patients."

To confirm his words, he told an incident that made me feel somewhat uneasy, although I, the daughter of a priest, was accustomed to stories of all kinds, but what I heard simply shocked me.

“I still can’t explain to myself in any way why a young, completely healthy 33-year-old man, returning from the gym, suddenly slipped and fell, breaking his head, receiving an injury incompatible with life. And at that very time, a man was dying in the hospital, who urgently needed a heart transplant... We managed... And now, he has been living with someone else’s heart for two years... And two more lives were saved - one received a kidney transplant, and another a liver - and all from a dead young man who, in fact, did not manage to do anything in this life, but with his death saved three people who were completely strangers to him. How and how can this be explained? Only one thing - it was predetermined. But not by me and not by any of us, doctors - by someone from above, I’m simply sure of this... Even the fact that you are asking me your questions here today is not an accident, but a pattern - that means it should be so...”

“Why did you choose cardiac surgery?

On this occasion, I’ll tell you a parable: “Once a man came into the temple and, looking at the priest’s cassock embroidered with gold, asked: “How can I get along just as well?” To which the priest replied: “Go to the basement, there you will find everything you want.” The man went down to the basement, and there were crosses - one more beautiful than the other. He grabbed a cross studded with diamonds and began to try to lift it. But no amount of effort could move the cross. And then he saw a cross made of pure gold. I was delighted and well, let’s try to pull the golden cross out of the basement. He fought and fought, but nothing happened - the golden cross only moved a little. Then the man, seeing the silver cross, somehow managed to lift it onto himself and dragged it up the stairs, but the stairs could not stand it and collapsed, and the man found himself crushed by the silver cross. And then he saw a small tin cross, reached for it and somehow slipped out from under the silver cross. He stood up, hunched over from bruises, took his cross in his hands and left the basement to the priest. “Well, did you find what you were looking for?” - he asked the man. “I found it,” he answered, showing his small cross. “Everyone has their own cross,” the priest told him. “Mine is in heavy robes, embroidered with gold, in day and night prayer work to take on your soul all your sins, and you have your own cross. Take it and go with God."

So, answering your question, I can, after what has been said above, only add - this is my cross, and I will bear it as long as I have the strength and opportunity to help people, returning them to a full life...”

Alexander Nikolaevich spoke a lot about his work and almost nothing about himself personally and about his family, and only once, in passing, he noted with regret that he could not devote as much time to them as he would like. And he spoke about one more thing with undisguised regret in his voice when the conversation turned to children. The regret was that only the youngest son expressed a desire to follow in his father’s footsteps.

Finishing our conversation, I asked what else a person like him could dream of, to which the professor replied:

“I really want my mother to live longer and for her dream to come true and for us, together with Alexander Vladimirovich Esipov, our flagship, to create our own Heart Transplant Center, and these are not my ambitions, I just really want to have more opportunities to help people...”

Saying goodbye to Alexander Nikolaevich, I caught myself thinking that this unsmiling Professor would remain a “doctor of the heart” for me, and not so much in essence, but in his state of mind...

Nadezhda DROBYSHEVSKAYA

Photo by Alexander Boyko

and from the hospital archives

Updated: September 27, 2016 — 5:03 pm

I don't know why this hospital is considered good. This has not been the case for a long time. There is no funding. For those who don’t believe it, in the courtyard behind the neurosurgery building there is a luxurious new building that has not been functioning for many years; expensive equipment is rotting in the basement, because there is no money to complete the building and put it into operation. My father was in the hospital under Sogaz insurance, we were transferred from the Central Clinical Hospital with a terrible diagnosis of brain cancer, we needed urgent surgery, at the end of December 2012. Without money, they won’t come to you at all and, what’s scary, they won’t come to you for money either. My father had a neurosurgical operation, a brain tumor was removed. The operation went very well, the surgeon Miklashevich Eduard Rishardovich is a professional from God, to the next. the day after the operation, my father was discharged from intensive care, he spoke and was completely adequate. But then, the New Year holidays arrived. And instead of getting better, my father almost died. There was no one left in the hospital. They don’t give doctors mobile phones, I sat with my father alone, the nurses only came in to give injections twice a day. No amount of money could make them work. Once, when leaving for the night, I left them a bottle of Italian champagne for 2,000 rubles, good chocolates and 1,000 rubles in cash so that they would come to him at night, because after the operation there was insomnia and nightmares at night. My father, always a strong and firm man, cried with fear like a child, they locked him in a stuffy room, so as not to apparently disturb the nurses’ sleep, and they took away the nurse call button, hid it behind the bed, he couldn’t reach it, I paid for a paid room with a TV, but they were even too lazy to turn on the TV for him! And he lay in the stuffiness, darkness, for hours without sleep, motionless, because he had paresis of the entire right side! In short, out of 4 nurses on duty, 2 were normal, and two were simply sadists. I did their work, sat with my father from 10 am to 10 pm and drove 55 km home every day (I live in Lyubertsy). So while I was away, they didn’t even always change his diaper and feed him! Although every evening before leaving I always left 500 rubles so that they would look after it! In Moscow this is a normal price for a nurse, but in this hospital the nurses don’t consider it money! I asked them to help me find a nurse, because it’s hard for me to travel every day, but they announced a price of 4,000 rubles per day! And then only after the holidays, because on holidays they rest. The doctors at the hospital are not much worse. During the holidays, we were left with 3 patients on the floor, who were apparently so sick that they could not be discharged. The doctors themselves were NOT suitable at all! Every time I caught them for half a day and dragged them into the ward. Despite the fact that immediately before the operation I gave everyone money and expensive cognac, then more after. And plus, my father acted like a commercial patient; the insurance company paid huge sums for us. This is the first time I have come across such a condition of a patient, I am not a doctor, I did not know what to do with a bedridden patient. And no one told me anything about how to care. No one even advised me to do something urgently or to hire a professional for money. Although, a physical therapy specialist and massage should have been provided to us free of charge by insurance! But the massage was only after the New Year holidays on January 10, and the exercise therapy specialist said that he would only do it for cash, because you see, from the money that the insurance company pays by bank transfer, he gets nothing, everything ends up in the administration . I tried to argue and say that I’m not an oligarch either, and that if insurance pays, then I don’t have to, but he was adamant. I had to pay him to put my dad back on his feet and teach him to walk again with his leg paresis. But that was only later, and at first I observed a deterioration in my condition every day. After a week of lying like this, my father was already talking and barely moving. I ran around the floors, looked for the doctors on duty, begged to come in, but they ignored me or came in just for show. And only one kind doctor, unfortunately, I don’t know the last name, with a Korean appearance, said that, it turns out, it was necessary to sit the patient on the bed from the 3rd day after the operation, taught me to do this, fixing it with a chair - and also taught me to do all sorts of procedures to avoid congestion in the lungs. I did it all myself, it was very difficult. Some nurses helped me change dirty wet sheets and diapers under my father, some frowned with disgust and refused to help. And most importantly, in the end, when the diagnosis of cancer was officially confirmed (histology, biopsy) - according to the insurance contract, they no longer had to pay for the treatment. And we were immediately discharged from the hospital. Bedridden patient. Which spruce spruce could take a couple of steps along the corridor with the support of a specialist. I asked and begged not to be discharged, there must be some kind of recovery, procedures, rehabilitation. I was ready to pay myself for a further stay. But no, we were kicked out. They didn't provide an ambulance or anything. We had to hire movers, they carried my father home in their arms, since we have a 2nd floor without an elevator. You know, this is a terrible hospital, terrible attitude towards patients. Even for money you are not people there.