Although the first ideas about the development of cardiovascular surgery were conceived in the early 1960s, the idea came to fruition in 1973, when today’s Institute of Cardiovascular Diseases “Dedinje” began operating as one of the departments of the Clinic of General Surgery of CHC “Dr Dragiša Mišović”. The new building, where then Institute for Cardiovascular Surgery started working, was completed at the end of 1977. The first director of the Institute was Prim. Dr. Dragoljub Adamov, and the Institute originally had 60 employees. In 1985, the Institute was fully functionally separated from the CHC “Dr Dragiša Mišović” and continued to operate under the name Clinic for Cardiovascular Surgery “Dedinje”. Since 1993, this institution has operated under the name the Institute for Cardiovascular Diseases “Dedinje”, which is the name it still carries. In 1996, a new building of the Institute was opened, which significantly increased the accommodation, diagnostic and therapeutic capacities.

Cardiovascular surgery

The today’s Institute for Cardiovascular Diseases “Dedinje” emerged from the Department of Vascular Surgery of the General Hospital “Dr Dragiša Mišović”. Upon its establishment this department had several rooms on the 3 rd floor, when prim. dr Dragoljub Adamov was appointed as the first head of the department. It all began with venous system operations, and surgical intervention on arteries followed soon after. The number of treated and operated patients was constantly growing, which indicated the necessity of the construction of a separate specialized institution which would provide diagnostics and treatment for cardiovascular patients. Thanks to prof. dr. Libor Hejhal and the Mayor of Belgrade at that point, Branko Pešić, a completely new and functional building was built and equipped within the complex of CHC “Dr Dragiša Mišović”, which had the opening ceremony in October, 1977.

The first appointed head of Prim. Dr. Dragoljub Adamov.

Alain Carpentier, MD, PhD, pioneer of modern mitral valve replacement surgery

Further Steps

The institution was a functional unit comprising radiology, cardiology, and cardiovascular surgery services. In its first two years, only myocardial revascularization surgeries were performed, and the staff became fully independent. The Institute gained a reputable standing in medical circles, but accommodation capacities became an issue as there were only 88 beds for all services. Many global experts participated in diagnostic procedures or performed surgeries with assistance from the Institute’s doctors (L. Hejhal, R. Hackee, F. Von der Emde, A. Carpanter, Y. Chavaouh).

Establishment of the Clinic for Cardiovascular Surgery “Dedinje”

Doctors from the Institute mastered complex revascularization and heart valve surgeries. In 1985, the Institute for Cardiovascular Diseases was fully functionally separated from the KBC “Dr. Dragiša Mišović” and continued to operate under the name Clinic for Cardiovascular Surgery “Dedinje”. In 1986, Prim. Dr. Dragoljub Adamov retired, and Prof. Dr. Mihailo Vučinić was appointed as the director of the Institute, serving until his retirement in 1992. Notable cardiothoracic surgeons, such as Dudley Johnson, Geoge Reul, Donald Ross, and Andzej Dziatkonjia, visited and operated at the Institute. In 1992, Prof. Dr. Milovan Bojić took over the leadership of the Institute.

Prof. Dr. Mihailo Vučinić, first director of the Clinic for Cardiovascular Surgery “Dedinje”.

Prof. Dr. Milovan Bojić

Construction of the New Building

Construction of a new division of the Institute started after the expansion of capacity. The number of beds increased to just over 200, while the number of employees increased to almost 600. All this allowed for the number of cardiac surgery procedures to increase to about 2,000, making the Institute one of the largest centers in Europe. Since 1993, after a continuous expansion in terms of the type and number of interventions, this institution has been operating under the name the Institute for Cardiovascular Diseases “Dedinje”.

Prof. Dr. Boško Đukanović, director of the Institute, who expanded the repertoire in cardiac surgery

Leading in the Region

In 2000, Prof. Dr. Boško Đukanović took over the leadership of the Institute and expanded its repertoire in the field of aorta surgery, making the Institute the leading institution in this area throughout the region. In January 2016, Prof. Dr. Predrag Milojević became the acting director of the Institute. Since October 2017, Prof. Dr. Milovan Bojić has again been at the helm of the Institute for Cardiovascular Diseases “Dedinje”.

Prof. Dr. Predrag Milojević, acting director of the Institute in 2016

First Transplants Performed at the Institute

In 1995, the first heart and liver transplants were performed. With the assistance of experts from the Texas Heart Institute (Oscar Howard Frazier Jr.), the Institute became the first in the region to implant a heart-mate as a temporary mechanical heart leading up to a planned transplant. International collaboration remains very active.

Vascular surgery

The Vascular Surgery Department of the General Hospital “Dr. Dragiša Mišović” began its operations in 1973, with its first head being Prim. Dr. Dragoljub Adamov. Prof. Dr. Libor Hejhal from the IKEM Institute in Prague provided invaluable assistance in the department’s early development, both through direct participation and by training our doctors in Prague. Initial surgeries targeted the superficial and deep venous system, quickly expanding to major neck and extremity arteries, while surgeries on visceral arteries were introduced later.

The relocation to the new building in 1977 resulted in a significant increase in the scope and complexity of surgical procedures. In the period 1977-1992 prim. dr Miodrag Jevremović was the head of vascular surgery, the position which was later taken over by the scholar prof. dr. Đorđe Radak, who held that position until 2019.

In the early 1990s, modern diagnostic and therapeutic surgical procedures were introduced, including open surgical interventions to treat portal hypertension and liver and pancreas transplant surgery. The first successful transplantations were performed in 1995. Eversion carotid endarterectomy was introduced as a standard in the surgical treatment of carotid disease. Three decades later, more than 18,000 of these procedures were performed, with above-average results at the level of the world’s best centers.

Cooperation with experienced invasive radiologists at our institute has resulted in the development of various endovascular interventions in treating abdominal aorta, carotid and peripheral arteries. The first implantation of an aortic stent graft was performed in 2004, after which the number of these procedures has been growing steadily on an annual basis, with excellent results.

The Clinic for Vascular Surgery is the first and the only state institution that provides patients with modern treatment of chronic venous disease by applying the method of endovenous laser ablation (EVLA). The first intervention was performed by doc. dr. Predrag Matić in April, 2019, and the minimally invasive nature of this procedure attracts more and more patients.

Since 2019, prof. dr. Nenad Ilijevski has been the head of the Clinic for Vascular Surgery, who made his first surgical steps in 1988, at the clinic he now manages. Prof. dr Đorđe Radak

Academician Prof. Dr. Đorđe Radak, manager of the Clinic for Vascular Surgery in the period 1992 – 2019

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Prof. Dr. Predrag Lalević, Director of the Clinic for Anesthesiology, Reanimation and Pain Therapy, KBC “Dr. Dragiša Mišović”

ANESTHESIOLOGY

It began operating in 1973 within the Cardiovascular Surgery Institute of the KBC “Dr. Dragiša Mišović” as the Anesthesiology and Resuscitation Department under the Anesthesiology, Resuscitation, and Pain Therapy Clinic of the KBC “Dr. Dragiša Mišović”, led by clinic director Prof. Dr. Predrag Lalević. With the founding of the Clinic for Cardiovascular Surgery “Dedinje” in 1985, the Department of Anesthesiology and Intensive Care had 6 specialist anesthesiologists with resuscitation, with the department head being Prim. Dr. Ilija Trifunović, and 10 nurses and medical technicians for anesthesia for 4 operating rooms, and around 34 nurses and medical technicians for intensive care with 15 beds. Soon, at the beginning of the 1990s, the daily practice began to include intraoperative blood salvage and acute normovolemic hemodilution, setting the conditions for about 40% of patients in cardio-surgery not to receive allogeneic (foreign) blood.

At the Institute for Cardiovascular Diseases “Dedinje” in 1995, a heart and liver transplantation program began. The then team of anesthesiologists, nurses, and technicians in anesthesia and intensive care department made a significant step into modern transplantation medicine by successfully transplanting the heart and liver as part of the Institute’s Transplantation Team and Consilium, led by Prof. Dr. Božina Radević and Doc. Dr. Boško Radomir, head of the Anesthesiology and Intensive Care Department. The following year, just six months after its introduction, the left ventricular surgical remodeling program for dilative cardiomyopathy was conquered, further promoting and encouraging the acquisition of new knowledge and experience in the field of heart failure.

At the same time, the surgical reconstruction program for the thoracic aorta intensified, advancing the anesthesiological concept of modern anesthesia in deep hypothermia and circulatory arrest and intensive treatment, introducing high thoracic epidural anesthesia, continuous intraoperative blood salvage, and acute normovolemic hemodilution, thanks to the many years of experience of the anesthesiology team with the same concept in vascular anesthesia.

CARDIOLOGY AND RADIOLOGY

The cardiology and radiology departments began operating in 1973 and significantly expanded their fields of activity shortly after the opening of the clinic’s new building in October 1977. The first head of the Cardiology Department was Prim. Dr. Petar Pejčić, and the Radiology Department was led by Prim. Dr. Zoran Đurišić. From 1973 to 1977, the primary activity of both departments was the diagnosis and preparation of patients undergoing vascular surgery, as well as their subsequent post-operative management. The first arteriography was performed in 1976, and that same year, phlebography and splenoportography were successfully introduced. Moving to a new building significantly expanded the technical capabilities of these two departments as the most modern X-ray machine at the time was procured. The first coronary angiography was performed in 1977.

The coronary angiography team (doctors Pejčić, Đurišić, and Grujičić, technician Nikolić, and nurse Lekić) was thoroughly educated with the assistance of professors Fabijan and Belan from Prague. After the start of cardio-surgery in 1978, the Cardiology Department took over the pre- and post-operative care of these patients. As a logical continuation of introducing the latest treatment methods to the Clinic for Cardiovascular Surgery “Dedinje”, the first percutaneous coronary angioplasty was performed in December 1981. A year earlier, Dr. Đurišić and Dr. Grujičić performed a similar intervention on the femoral artery. A special place in the history of Serbian invasive cardiology is held by Dr. Uroš Babić, who, with his innovative approach, significantly advanced the treatment of patients with mitral stenosis and atrial septum defect at a global level. Dr. Babić, from 1985 to 1989, developed original methods for treating these patients and, for the first time in the world, together with Dr. Grujičić, used them in routine clinical practice. The first stent was implanted in the femoral artery by Dr. Grujičić and Dr. Đurišić in 1990, and six years later, the first stent in the coronary artery was implanted by Prof. Dr. Dragan Sagić and Prof. Dr. Milutin Mirić. The move to a new building in 1996 significantly increased accommodation, diagnostic, and therapeutic capacities, marking a turning point in the development of cardiology and radiology. The new building housed 4 X-ray rooms and a space for a scanner, which was procured in 2005. The increase in workload also necessitated new organization, leading to the founding of the Cardiology Clinic and the Center for Invasive and Interventional Cardiovascular Diagnostics and Therapy.

The new millennium brought new challenges in treating cardiovascular patients. In 2004, the first aortic stent graft was implanted (Prof. Dr. Sagić, Dr. Antonić, Prof. Dr. Radak). The first permanent pacemaker (type VVI) implantation in the Institute and Serbia was done by Prim. Dr. Dragoljub Adamov in 1966. The Electrocardiology and Electrostimulation Department was formed in 1996. Dr. Lazar Angelkov performed the first implantation of a cardioverter-defibrillator in 1997, and in 1998, he performed the first multisite pacemaker implantation for heart failure for resynchronization therapy in Serbia.

The first radiofrequency ablation on the Institute was performed in 1994 by Prof. Dr. K.H. Pitschner from Bad Nauheim (Germany), after which doctors Vukajlović and Angelkov mastered this procedure. Heart ultrasound diagnostics (echocardiography) have been conducted at the Institute for Cardiovascular Diseases “Dedinje” since 1985. The Center for Cardiovascular Research was also founded in 1996 and is the brainchild of Doc. Dr. Aleksandar D. Popović, aimed at consolidating and coordinating the enormous scientific research potential of the entire Institute in one place.