Interview with the Head of the Cardiac Surgery Clinic at UMHAT "St. Marina" – Varna, Assoc. Prof. Dr. Vladimir Kornovski in clinica.bg
You are taking over the largest Cardiac Surgery Centre in North-Eastern Bulgaria.
What are the challenges you are facing?
Taking over a Cardiac Surgery Clinic at a University Hospital implies a responsibility that goes beyond day-to-day operational activities. It encompasses the clinical level, the academic mission and the sustainable development of a highly specialised medical facility.
The challenges are clearly outlined – maintaining and upgrading clinical standards commensurate with modern cardiac surgery, with high volume and increasing complexity of cases, development of minimally invasive techniques such as real clinical practice requiring experience, team maturity and consistency, forming a professional environment in which knowledge and experience are systematically and responsibly imparted.
The responsibility for making the right choice is fundamental to every clinical decision – not between possible techniques, but between what is medically justified and what is formally permissible. It is precisely this ability to differentiate, exercised consistently, that determines the maturity of cardiac surgery and establishes the Clinic as a reference environment for treatment and informed choice for the patients in the region.
What are your plans for the development of the Clinic?
The Cardiac Surgery Clinic in Varna has a clearly defined history and consistent line of development for more than two decades. Since its establishment in 2005, with the team of Prof. Gencho Nachev, and subsequently under the leadership of Prof. Vladimir Danov and Prof. Plamen Panayotov, its development has followed a step-by-step and logical integration of modern cardiac surgery approaches.
Throughout the years, beating heart coronary revascularisation, more extensive use of arterial grafts, valve-sparing interventions preserving the integrity of the sternum, minimally invasive bypass, and cryoablation for atrial fibrillation have been introduced. This development stems from a sustainable surgical concept rather than isolated technological solutions.
The current focus is on the consistent advancement of minimally invasive cardiac surgery as part of routine practice. In this context, the Clinic has already resumed endoscopic-assisted interventions in mitral valve pathology. Presently, we have patients recovering from surgeries performed entirely by the team at the Clinic, which proves that the development is based on real clinical practice and accumulated experience.
Do you have a sufficient number of personnel? What about medical residents?
Cardiac surgery is a team discipline in which the quality of the outcomes stems from the professional synergy among surgeons, clinical cardiologists, interventional cardiologists, anaesthesiologists, perfusionists, and healthcare specialists, rather than from individual efforts.
The shortage of healthcare professionals is a systemic issue that affects the entire healthcare system. Meanwhile, the surgery team at the Clinic is a stable one, consisting predominantly of young physicians with high professional potential.
University cardiac surgery requires continuity. The training of specialising doctors requires clinical volume, a spectrum of pathologies and an established professional environment – prerequisites that the Clinic provides. Specialisation should be a conscious choice and a real initiation into a surgical school, and in this sense, the Clinic has every reason to establish itself as a natural venue for educating future cardiac surgeons.
The hospital environment is becoming increasingly competitive. What impact does this place on the quality and accessibility of cardiac surgery services?
In modern cardiac surgery, quality and accessibility are assessed using clearly defined professional criteria laid down in internationally recognised clinical guidelines and best practices. The key factors are consistency in clinical decisions, clear indications for treatment and reproducibility of results.
In this respect, real accessibility to cardiac surgery is not assessed formally, but rather through the patient's ability to be treated in an environment that complies with established global standards and ensures a predictable and safe course of treatment.
When clinical practice is guided by these principles, quality and accessibility are not opposing concepts, but complementary ones. This is what creates a sustainable foundation for building trust and ensures that patient care meets the standards of modern cardiac surgery.
Is there a need for more cardiac surgery centres in the country, including paediatric ones?
This is a strategic issue that should be addressed at institutional and expert level. Forming a cardiac surgery team for adult patients is relatively easier, although it is accompanied by personnel challenges.
Paediatric cardiac surgery, on the other hand, is a completely different field – it requires a highly specialised, multidisciplinary team and long-term planning. Each decision to expand this capacity should be based on actual morbidity and available resources.
How does the advancement in technology affect treatment in cardiac surgery? What role does artificial intelligence play?
Modern technological developments in cardiac surgery are aimed at reducing surgical trauma and optimising postoperative recovery. Minimally invasive, endoscopic, and robotic approaches are a logical continuation of this development.
Artificial intelligence is being used as an analytical tool for risk assessment, intervention planning, and complication prognosis. It does not replace clinical judgement, but rather supports it by expanding the possibilities for informed decision-making.
Is there a decrease in the number of patients undergoing heart surgery due to the development of invasive cardiology?
Yes, this is a clearly observable trend. Invasive cardiology has significantly expanded its therapeutic capabilities, which requires even closer cooperation between specialities.
Treatment decisions should be the result of the activities of a multidisciplinary, working Heart Team, not just one existing on paper. Patients should also be involved there, as direct participants in the choice of therapeutic strategy. The long-term outcome for the patient should remain a priority, rather than the immediate technical opportunity.
What are your expectations regarding the new framework agreement?
Cardiac surgery is a high-risk and resource-intensive speciality. Maintaining a high level of quality, personnel stability, and opportunities for development requires adequate valuation of the activities.
The new framework agreement should take into account the real complexity and responsibility of cardiac surgery treatment in order to achieve sustainable development of the system rather than merely formal functioning.
Are we getting more health aware, or do patients continue to seek treatment at an advanced stage of the disease?
Health awareness is gradually increasing, nonetheless, late diagnosis continues to be a serious problem. A significant proportion of patients are admitted for treatment at an advanced stage of the disease.
Early referral, prevention, and systematic monitoring remain key to improving long-term outcomes and expanding therapeutic options.
Assoc. Prof. Dr. Vladimir Kornovski graduated from Medical University - Varna in 2002. In 2009, he acquired a speciality in Surgery, and in 2014 - in Cardiac Surgery. In 2019, he defended a dissertation on intraoperative assessment of blood flow in coronary surgery and acquired the educational and scientific degree of doctor. His research interests lie in the field of objectification and optimisation of results in cardiac surgery. Since 2022, he has held the academic title of Associate Professor. He completed a Master's degree in Health Management in 2023. Since 2025, he has been part of the team of UMHAT "St. Marina" – Varna.
