Pioneering work in cardiology in Satakunta

Text: Kreetta Haaslahti, Photos: Julia Hannula, Johanna Sjövall

The Department of Cardiology at the Satakunta Central Hospital is a forerunner that is well known in Finland, but also internationally. Throughout its history, the unit has shown initiative in research and introduction of new technologies, while industriously carrying out vital basic operations to promote the health of the patients: around 1,200 contrast matter imaging producers of the coronary arteries and 500 PCTA operations are conducted in the unit annually. Furthermore, around 200 pacemakers are fitted. This equals more than five daily procedures if divided over the course a year.

The Department of Cardiology was established in 1998. After a few years, cardiologist Pasi Karjalainen, who was invited by the Deputy Chief of the unit at the time, Antti Ylitalo, arrived in Pori and the Department of Cardiology.
“First, it was just me and Antti for a while. More cardiologists have joined us throughout the years, and at present there are five permanent cardiologists at the department. A few years back, Antti moved to Turku and I became the Chief of Department. Antti’s office is shared between Turku and Pori, so he still works part of his hours in Pori. We also have 3–4 specialising doctors and around 20 nurses,” says Chief Physician Karjalainen in describing his work community.

Antti Ylitalo (vas.) ja Pasi Karjalainen © Julia Hannula

Antti Ylitalo (left), had an important role in the establishment of the Department of Cardiology in Pori in 1998. A few years later, Pasi Karjalainen joined him.

Active research activities

There are five University Hospitals and 16 Central Hospitals in Finland at present. Extensive research activities are not traditionally conducted at Central Hospitals, but the Department of Cardiology of the Satakunta Central Hospital is an exception to this rule. This is particularly true if research activity and its significance is measured by publications in international journals.
“I have been here for 15 years, and we have completed almost 100 publications during that time. It is more than many University Hospitals have completed in the same time,” Karjalainen points out.

Research has awarded the Department of Cardiology of the Satakunta Central Hospital reputation, but first and foremost it has benefitted the patients.

Research has awarded the Department of Cardiology of the Satakunta Central Hospital reputation, but first and foremost it has benefitted the patients.
“We do not work with molecule-level research here; we carry out clinical trials that help us with patient work in practice.

With qualified people and state-of-the-art technology

Active research activities are reflected in the annual statistics of the National Institute for Health and Welfare, as a low death rate in myocardial infarction care in Satakunta.
“The fact that we have been actively involved in research has attracted qualified doctors here, and consequently our results are above the national average."

Pasi Karjalainen © Julia Hannula

Chief Physician Karjalainen monitors the progress of a contrast matter imaging procedure on the screen.

The Department of Cardiology has a thing for technology, too.
“A number of new technologies have arrived in Finland so that we have first started to use them here and others have followed our example.

The first example of such technology was the OCT machine for optical tomography of the coronary arteries, which was acquired with research funding provided by the state.
“We were the first in Europe to begin the research of cardiac arteries using an OCT machine in 2009. Over the years, we have completed around twenty publications on the topic as well as three dissertations, which I supervised.”

Today, OCT machines are used in all Finnish hospitals.
“Thanks to the OCT examination, the PCTA procedure is safer than before to the patient.”

“In the summer of 2016, we fitted a patient suffering from coronary disease with the first biodegradable mesh tube of magnesium alloy.”

Biodegradable mesh tube and wireless pacemaker

In a PCTA procedure, the narrowed coronary arteries are opened. Usually, a mesh tube, also knows as a stent, is fitted in the artery to prevent a new blockage in the treated area. There are many kinds of stents available, and they have been one of the topics of research at the Satakunta Central Hospital. An example of the most advanced technology is the biocorrodable mesh tube that degrades in the patient’s body once it has completed its task.
“Before, the stents were always made of a metal alloy and they remained in the vein for good. In the summer of 2016, we fitted a patient suffering from coronary disease with the first biodegradable mesh tube of magnesium alloy in Finland. The mesh tube will disappear during the first year and practically nothing will stay behind in the vein. For some of the patients, this is an excellent technique.

TAVI-toimenpide käynnissä © Johanna Sjövall

Pictured: a fitting of an aortic valve through the femoral artery. On the right, Chief Physician Pasi Karjalainen, in the foreground radiographer Juha Normio and behind him the Chief of Department Tuomas Paana © Johanna Sjövall.

Wireless pacemakers are also finally a reality when, after dozens of years of development work, it has become possible to fit the pacemaker battery in a sufficiently small space.
“The first wireless pacemaker in Finland was fitted for a patient here at our department in late 2015. Now, we have fitted them for a little over 20 patients.”

According to Karjalainen, the wireless pacemaker has both revolutionised and facilitated their work. A traditional pacemaker is often fitted into a pocket constructed in the chest of the patient, and the pacemaker wires are led to the heart through a vein. For some of the patients, this has resulted in an infection of the pacemaker and the patient has been hospitalised for several weeks, waiting for the infection to heal and to have a new pacemaker fitted. With a wireless device, such pockets or pacemaker wires are no longer needed.
“A small, wireless pacemaker is fitted through the groin and directly to the heart, using a catheter, and the patient is soon released from the hospital. New technology is always more expensive than old, but the prices usually go down rather quickly as the technology becomes more commonly used. And it is worth remembering that the benefits of new technology usually compensate for the more expensive price. such as the patient not having to spend so much time at the hospital.”

“It is important that a regional hospital can offer patients treatment that has previously been unavailable here.”

A wide range of operations for the patients’ benefit

Ablation procedures for atrial fibrillation and aortic valve repair operations are among the procedures carried out at the Department of Cardiology at the Satakunta Central Hospital. In an aortic valve repair, the artificial aortic valve can be fitted through a vein. Both operations are easy for the patient – all you have to do is lie awake on the operating room table. The results of the operations, however, are significant. For elderly patients, a new aortic valve can mean 10 more years of life.
“It is important that a regional hospital can offer patients treatment that has previously been unavailable here.” It also helps in attracting competent doctors here. If we only carried out basic procedures, it would probably lead to the experts seeking positions elsewhere.

Here, Karjalainen also wants to emphasise the importance of hospital management.
“The management has been extremely positive about what we do. We have received support, we have had the chance to conduct research and introduce new technology."

Sydänyksikön Pori-palkinto © Julia Hannula

The Pori Award, granted in 2009, adorns the wall of the Department of Cardiology; the City Board granted the award as a recognition of excellence in the treatment of cardiac diseases and work that has gained reputation throughout Finland.

Growing into a cardiologist in Pori

Karjalainen describes the Department of Cardiology as a small and closely-knit work community. It is rewarding to see the patient really benefits from the procedure that has been completed.
“Or, when it comes to research, receiving an email from a prestigious journal with the message of an article having been accepted for publication. It does feel good, at least for a moment.”

It must also feel special to know how many specialists have been trained in Satakunta and now take care of patients around Finland.
“When a young, aspiring doctor asks Juhani Airaksinen, Professor of Cardiology at the University Hospital in Turku if it is possible to specialise in cardiology, he will say that sure, but you have to train in Pori first. We have trained over 30 cardiologists here who have later transferred to the university cities, such as Turku, Tampere, and Helsinki.”