Proactive prevention – an emerging frontier in medicine

by Stefanos Demertzis on 16 March 2025

Many of the diseases needing open heart surgery are preventable or at least partially preventable. Others are of degenerative nature and currently not really preventable. We have been pretty successful preventing rheumatic valve disease in our context as a rich country thanks to the precise diagnosis and antibiotic treatment of streptococcal infections (mainly sore throat). Our success in preventing coronary heart disease is less spectacular. Every time when performing coronary bypass surgery it’s inevitable to think of cardiovascular risk factors, such as metabolic syndrome, obesity, poorly controlled / balanced blood fats, smoking, high blood pressure. We and our partners in Interventional Cardiology got pretty good in repairing the various life-threatening sequelae of coronary heart disease (and other diseases, as well), which is without doubt an excellent achievement of modern medicine. In fact, current medicine is primarily focused on precise, diagnosis and effective treatment. With an explosion in understanding physiology and pathophysiology down to cellular, molecular and genetical level, focus is shifting. The emerging medical discipline is prevention. Not only prevention of one or a series of diseases but preventing cells and tissues to stray off their path of healthy function embracing the inevitable biological process by aiming for a healthy aging to the highest possible degree.
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A complex and only partially decrypted code of the heart: Heart Rate Variability

by Stefanos Demertzis on 29 July 2024

An emerging tool allowing for some visual to internal balance, stress resilience and healthy longevity.

The heart rate is defined by the number of heartbeats per minute (bpm). As with any biological measure a range of values is defined as normal taking into consideration the age and biological sex. In the case of heart rate this range (at rest) is for adults between 60 and 100 bpm with significant individual variations depending on fitness level, health conditions and idiosyncrasy. Even at a constant heart rate (bpm), the timely distance between singular heart beats varies despite the same final count per minute. This phenomenon is called Heart Rate Variability (HRV). The fluctuation of heart rate is the result of complex dynamic and non-linear interactions of several physiological systems.
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Re-connect

by Stefanos Demertzis on 6 November 2023

More than 3 years have passed from the last post. Dense and intense years due to a series of issues. Among them the pandemic, major institutional changes, a significant academic and teaching engagement with the new Master of Medicine at the USI, the conclusion of a Master in Diving & Hyperbaric Medicine at the University of Padova and most of all, sadly, a major loss in the family. Now, however, it’s time to re-connect. We will re-connect through a collection of topics, such as prevention of cardiovascular diseases and diseases in general, trends in heart medicine, topics on longevity research and much more.

SARS-CoV-2 pandemic: complex systems wobbling

by Stefanos Demertzis on 30 April 2020

We live in a complex system. Complex systems are those that are intrinsically difficult to model due to interactions between their parts or between a given system and its environment. Their reaction to a given input is unpredictable. The capacity of a complex system to absorb hits and disturbances and still retain basic function and structure is called resilience. Non-resilient systems destabilize and mutate to new, most frequently, less desirable states1. The coronavirus disease (Covid-19), the pandemic disease caused by the SARS-CoV-2 virus, demonstrates how susceptible our complex systems are, when the disturbance cannot be controlled rapidly and effectively.

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Cardiac surgery and sports

by Stefanos Demertzis on 9 December 2018

The topic might seem a contradiction, how can it be possible to engage in intense sport with an operated heart? It is possible, but not for everyone and not in each case. The topic is complex and requires a differentiated approach. The major components of the equation are the following:

  • Nature of the disease
  • Functional condition of the heart
  • Response of the heart and of the whole cardiovascular system to the operation
  • Presence of any residual or other disease with particular relevance to intense sport
  • Attitude of the patient and his/her family
  • Sports history of the patient

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Minimally invasive valve surgery: cannulation of the right axillary artery.

by Stefanos Demertzis on 16 October 2018

Our surgical technique for cannulation of the right axillary artery and fully percutaneous TEE-guided cannulation of the right atrium in minimally invasive valve surgery is presented with a video in the CTSNet. Our data point towards a better cerebral protection with this technique.

Taking teaching of (cardiac) surgery to another level

by Stefanos Demertzis on 7 August 2018

I very well remember my first experiences as a medical student in the operating room. I was ordered to stand in a corner with my back to the wall (just as the surgeon ordered), almost motionless because of the staff’s worry that I might touch and contaminate something sterile. I could only listen to the surgeon describing what he was doing. That was a humiliating experience and I was close to abandoning my goal of becoming a surgeon.

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States of mind: #2 – Quality of care

by Stefanos Demertzis on 10 March 2018

Quality of medical and surgical care is a profoundly felt need of every patient, of every involved family. Although based on slightly different motivations, the same is requested by those who pay for the care. Therefore, the interest in defining and measuring the quality of provided care is high. This is, however, a highly complex endeavor. It requires in-depth knowledge, differentiation, multiple perspectives and expert judgment.

How can we define “quality of care”?

The Institute of Medicine (IOM) of the US National Academy of Sciences defines it as “the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”

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