November 2014, Sofia, Bulgaria

State-of-the-art Cardiac and Vascular Hospital

www.cityclinic.bg1

City Clinic hospital in Sofia has been registered as a multi-speciality acute care hospital. The hospital provides 5 (five) principal clinical service lines as follows:

Cardiology and Vascular Medicine

Cardiac Surgery

Vascular Surgery

Internal Diseases with a focus on Gastroenterology, and

Neurology

More than 80% of the hospital admissions are due to heart and vascular diseases. Within one year of operations City Clinic established itself as the leading provider of cardiovascular services in Bulgaria.

The hospital has 4 (four) operating rooms, two of which are dedicated to heart surgery. The remaining two are for general purposes and are currently used primarily for vascular surgery.

City Clinic Sofia has 2 state-of-the art catheterization laboratories. The wide range of interventional (minimally invasive) procedures are the main differentiating features of City Clinic.

City Clinic Sofia is also a leader in endoscopic procedures, including upper GI endoscopy, colonoscopy, bronchoscopy and ERCP.

The primary focus of the neurology practice is treatment of ischemic stroke including intra-venous (IV) tPA and intra-arterial (IA) tPA treatment.

The hospital has a outstanding ICU infrastructure with the latest state-of-the-art technology.

City Clinic Sofia –Main Lobby and a Patient Room

City Clinic SofiaFACT SHEET

www.cityclinic.bg2

Vision

The vision of City Clinic is to become the leading provider of highest quality, world-standard healthcare services in Bulgaria and the region.

Mission

The mission of City Clinic is to provide compassionate, patient-centered, high quality healthcare to its patients.

Values

Quality

Collaboration

Integrity

Compassion

Care Continuum of Medical Services at City Clinic

Operational Objectives at City Clinic

Corporate Structure & OrganizationVISION, MISSION, VALUES

www.cityclinic.bg3

With more than 3,500 hospitalized cardiovascular patients in 2013 and close to 5,000 in 2014, City Clinic is a market leader in diagnostics and treatment of cardiovascular diseases in Bulgaria and the region.

With more than 2,200 cardiology interventions in 2013 and more close to 3,500 procedures in 2014, City Clinic is the absolute market leader in Bulgaria in interventional procedures.

City Clinic is the largest cardiovascular center in Bulgaria and among the leading centers in eastern Europe.

Using the Cleveland Clinic Institute Model, City Clinic Heart and Vascular Center is a unique integrated unit for treating cardiovascular diseases combining the following clinical specialities:

Cardiology;

Interventional Cardiology;

Rhythm Management and Pacing;

Vascular Medicine (Phlebology and Angiology)

Cardiac Surgery;

Vascular Surgery;

Interventional Radiology.

It is a reference center of Philips for interventional and imaging equipment as well as reference center of Medtronic for specific interventional procedures.

Market Leader Cardiology International Magazine featuring City Clinic

Number of Inpatient Admissions of Cardiovascular Patients (2014)

3500

700

600

CardiovascularMedicine Admissions

Cardiac SurgeryAdmissions

Vascular SurgeryAdmissions

www.cityclinic.bg4

City Clinic has hired one of the most reputable and respected clinicians in Eastern Europe. The clinical team is led by Professor Ivo Petrov, voted by various poles as the best doctor in Bulgaria

Professor Petrov is a former Chairman of the Bulgarian Society of Cardiology. He is a member of the Board of the International Society of Endovascular Specialists (ISES), Fellow of the American College of Cardiology, Fellow of the European Cardiology Society and many other industry organizations.

Professor Petrov is a frequent presenter at Cardiology and endovascular forums throughout the world including Euro PCR, Veith, TCT, iCON, the meeting of American College of Cardiology etc.

Other prominent physicians of the City Clinic Team include: Professor Lachezar Grozdinski, Assoc. Professor Lachezar Penev, Assoc. Professor Marko Klissurski, Dr. Valentin Dikov.

Professor Grozdinski is the Chairman of the Bulgarian Society of Angiology and Phlebology. He is the most prominent Bulgarian vascular medicine specialist.

Prof. Penev is the Chairman of the Bulgarian Neuroradiology Society. He has spent more than 15 years working in the Middle East and is among the very few specialists experts on 3T MRI Images. He is a frequent speaker at international forums such as the Annual meeting of the European Society of Neuro-radiology.

Prof. Klissurski is the leading stroke physician in the country. He is a university professor with rich experience in Neurology. Also he is the only European licenced physician in neuro-sonography in Bulgaria.

Excellent Clinical Team & Reputation

Professor Ivo Petrov presenting at a Philips Event

The research interests of the City Clinic physicians range from cardiovascular diseases, including stem cell treatment for acute-myocardial infarction through advanced methods such as trans-catheter chemoembolization for primary lever carcinoma to neurodegenerative diseases such as MS and Alzheimer.

Additionally, City Clinic has started a campaign to bring prominent Bulgarian physicians working abroad back to Bulgaria.

An example of that is Dr. Valentin Dikov, who is one of the most reputable Bulgarian cardiac surgeons. Prior to returning to City Clinic to head the surgery practice, Dr. Dikov has worked for more than 20 years in Germany in leading university hospitals. He is a Fellow of the European Association of Cardiothoracic surgeons.

www.cityclinic.bg5

City Clinic is equipped with the latest state-of-the-art medical equipment.

The imaging department of the hospital is equipped with unique equipment:

• Philips 3T MRI with Ambient Experience;

• Philips 128-slice CT Scanner with iDose 4;

• Philips Digital Mammo Machine – MammoDiagnost

• MDC PACS

City Clinic is extremely proud with the capabilities of the 2 interventional laboratories (Cath Labs) in Sofia.

State-of-the-art Technology Philips 3T MRI with Ambient Experience

Philips Interventional X-Ray

www.cityclinic.bg6

City Clinic pursues affiliation with leading international healthcare providers ensuring access to the most advanced knowledge and most recent medical research.

Since early 2014, City Clinic Sofia hospital has become a teaching hospital of Varna Medical University and Sofia University “St. KlimentOhridksi”.

Some of the most successful partnerships include Partners Healthcare International (formerly Harvard Medical International), Arizona Heart Institute, etc.

City Clinic has affiliation with Massachusetts General Hospital and Brigham and Womens’ Hospital in Boston on various projects including:

• Hospital Accreditation;

• Quality and Patient Safety;

• Nursing Education and Nursing Leadership;

• Clinical Training.

Strategic Partnerships & Industry Recognition City Hospitals Affiliations

www.cityclinic.bg7

City Clinic hospital building in Sofia is a world-class healthcare facility, designed and constructed based on the latest evidence-based healthcare design and architecture principles. It provides the highest quality, most modern diagnostic and treatment services to the population of Sofia and the region.

The conceptual design of the hospital building was issued by one of the world’s leading healthcare architectural firms HKS Architects in Dallas, Texas.

The interior design was also developed by the HKS in-house design practice by creating a unique patient environment, never existing in this part of the world before. The interior colour palette brings the beautiful external landscape of the Vitosha mountain inside the building.

City Clinic hospital facility is a 4,500 sq. m building, situated at the South part of Sofia Ring Road. In recent years, Sofia Ring Road has turned into an intra-city highway by being the avenue with the second most intensive traffic in Sofia, only next to the TsarigradskoChaussee.

The building is very close to the second leg of the Sofia metro. There is a regular shuttle bus for patients and personnel from the last station of the Sofia underground metro to the hospital.

In the 2013 edition of the annual “Building of the Year” competition, City Clinic facility received the Healthcare Building of the Year award.

OverviewHOSPITAL BUILDING

City Clinic Building of the Year Award

Location of the City Clinic Sofia Hospital Building

www.cityclinic.bg8

Heart & Vascular Center

City Clinic Sofia offers a comprehensive portfolio of services for treatment of heart and vascular diseases. The organization of the Heart and Vascular Center allows a high degree of multi-disciplinary collaboration among various clinical specialties.

City Heart & Vascular Center is one of the leading centersin Eastern Europe providing all possible cardiovascular services.

The excellent clinical collaboration and team work have allowed City Clinic to perform extremely complex and sophisticated multi-disciplinary interventions such as:

Trans-Aortic Valve Implantation (TAVI)

Endovascular Aortic Repair (EVAR)

Thoracic Endovascular Aortic repair (TEVAR)

Carotid Artery Stenting (CAS) and Carotid Endarterectomy (CAE)

Peripheral Angioplasty and Stenting

Venous endovascular procedures

Renal Angioplasty and Stenting

Renal Denervation

Catheter ablations and implantation of pacemakers and automatic cardioverter-defibrillators

Cardiovascular Procedures Summary

Interventional Procedure at City Clinic

Clinical profileHEART & VASCULAR CENTER

www.cityclinic.bg9

Clinical Cardiology and Vascular Medicine

City Clinic offers the latest innovations in cardiac care and clinical therapies to patients of all ages. We provide state-of-the-art tests and procedures for accurate diagnosis and planning of treatment. Our cardiologists offer broad treatment options, including lifestyle modification recommendations, medications and procedures, and they work closely with our cardiovascular surgeons

Our cardiologists treat all kinds of heart and blood vessel diseases including:

− Heart attacks;

− Myocardial infarction;

− Valve diseases;

− Adult congenital heart disease;

− Treatment of heart failure;

− Aortic disease;

− Coronary artery disease;

− Periphearl arthery disease;

− Atherosclerosis;

− Hypercholesterolemia and risk factor modification.

ECG and Stress Test at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg10

Electrophysiology and Pacing

The Electrophysiology Laboratory at City Clinic performs diagnostic, therapeutic and interventional electrophysiology based procedures:

− Pacemakers;

− Internal cardiac defibrillators;

− Loop devices;

− Biventricular devices;

− Mapping of complex arrhythmias;

− Catheter ablation for atrial fibrillation/ flutter, supraventricular tachycardias, ventricular arrhythmias, complex arrhythmias as well as for patients who have previously failed ablations;

− Transseptal punctures and epicardial ablations;

− External or internal cardioversion;

− Device lead extraction;

− Use of intracardiac echocardiography.

City Clinic operates with the latest technology for diagnostic procedures and ablations provided from St. Jude Medical and Philips. It is the first hospital in Eastern Europe to install the state-of-the-art EP Navigator from Philips with a 56-inch high resolution LCD display of EP cockpit XL.

The St. Jude Navex and Illumien make the EP lab of City Clinic one of the most advanced labs in Eastern Europe.

Electrophysiology Procedure at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg11

Cardiovascular Imaging

The section of cardiovascular imaging at City Clinic Sofia provides clinical expertise in the diagnosis and treatment of patients with a heart disease affecting the structure or function of the heart.

Cardiovascular imaging section utilizes the newest technology to image the heart and vessels.

The following diagnostic studies are utilized to diagnose heart disease, plan optimal care for patients, and help ensure the treatment is complete

− Echocardiography, including Doppler and 3-D

− Stress echocardiography

− Transesophageal echocardiography (TEE)

− Intracardiac echo (ICE)

− Cardiac MRI including Cardiac MRI stress test

− CT Angiography

City Clinic has a wide array of cardiac ultrasounds including the gold standard machine of Philips – the IE33 with xMatrix.

TEE tests are performed at various parts of the hospital including the ICU and Operating Rooms.

Echocardiography Test at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg12

Cardiac Surgery

The Department of Cardiac Surgery offers virtually every type of cardiac surgery including elective or emergency surgeries in case of a heart valve disease, aortic aneurysm, coronary artery disease, arrhythmias, heart failure, Marfansyndrome and other less common conditions.

City Clinic cardiac surgeons have vast experience and expertise in all areas of heart surgery including:

− Bypass surgery

− Valve surgery

− Congenital heart surgery

− Aortic surgery

− Atrial fibrillation surgery - maze procedure, modified maze

− Hypertrophic cardiomyopathy surgery - septalmyectomy

− Heart failure surgery left ventricular assist devices, left ventricular reconstruction, and other innovative surgeries

The hospital operates with 2 dedicated Operating Rooms for cardiac surgery.

The cardiovascular team performs a good number of patient friendly minimally invasive surgeries such as Off-pump coronary artery bypass surgery (OPCAB).

Open Heart Surgery at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg13

Vascular Surgery

The Department of Vascular Surgery treats patients with all types of vascular aortic and venous problems including:

Peripheral Artery Disease (PAD);

Abdominal Aortic Aneurisms (AAA);

Thoracic Aortic Aneurisms (TAA);

Varicose veins;

Venous embolism;

Thrombosis;

Trauma, lesions, ruptures and other vascular surgeries.

The Department is one of the leading vascular practices in Sofia, performing both open and endovascular interventions.

About 50% of the vascular interventions performed in City Clinic are aortic surgeries.

Vascular Surgery Operating Room at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg14

City Clinic Sofia is equipped with the latest medical technology in the area of cardiac and vascular diseases. Such technology allows us to perform the latest and most advanced procedures and interventions in the cardiovascular care.

Medical Technology Employed at City Clinic Sofia

City Clinic

Clinical profileTECHNOLOGY IN CARDIAC AND VASCULAR CARE

www.cityclinic.bg15

Internal Diseases / Endoscopy Practice

The Department of Internal Diseases at City Clinic has 3 principal lines of operations:

Gastroenterology;

Pulmonology;

Endocrinology;

The predominant part of the patients treated at the department are patients with gastrointestinal (GI) diseases.

City Clinic has a state-of-the-art endoscopy suite equipped with the most advanced endoscope on the market –Olympus Excera III.

In 2013 alone, there were 833 endoscopic procedures performed. 95% of these were GI procedures whereas the balance was made by bronchoscopies.

The clinical team at City Clinic performs a wide range of endoscopic procedures including:

• Colonoscopies;

• Upper GI Endoscopies;

• Sigmoidoscopies;

• ERCP;

• Endoscopic Interventions and Resections.

Endoscopy Room at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg16

Neurology / Stroke Service

City Clinic Sofia has a relatively small neurology practice focused mainly on ambulatory patients and stroke treatment.

The purpose of the Department at this stage is to be complementary to the interventional radiology practice.

In 2013 and 2014 there were close to 200 stroke patients. About 10% of them received interventional treatment through either Intra-arterial (IA) tPA administration or mechanical thrombus aspiration.

City Clinic is at the fore front of the implemented technologies using advanced methods such as flow-diverter stents and mechanical aspiration.

Most of the people currently treated are ischemic stroke patients, while in the future with the development of neurosurgery practice a full scope of neurology services will be offered.

Our physicians perform a wide range of functional neurology testing including:

• EEG;

• EMG;

• Evoked Potentials;

• Echo Doppler.

EEG Test at City ClinicClinical profileHEART & VASCULAR CENTER

www.cityclinic.bg17

Diagnostic Imaging

City Clinic has the first of its kind 3T (Tesla) Magnetic resonance Imaging (MRI) machine in Bulgaria and the region.

The Philips Ingenia Wide-Bore 3 Tesla magnetic resonance imaging scanner was designed to make exams quick and comfortable for patients, while providing the clearest images possible of the human anatomy, thus improving diagnostic accuracy.

The MRI is also coupled with a unique ambient experience lighting solution designed to reduce anxiety among claustrophobic and pediatric patients.

City Clinic also has 128-slice CT scanner with the only dose reduction software in Bulgaria iDose 4.

The imaging services provided by City Clinic include:

− Digital radiography and fluoroscopy (X-Ray)

− Computed Tomography (CT)

− Interventional Angiography

− Calcium Scoring Test

− Magnetic Resonance Imaging (MRI) examination

− Mammography

− Total Body CT Scan

− Ultrasound examination

− Virtual colonoscopy

Philips 3T MRI with Ambient Experience at City Clinic

Philips 128-Slice CT Scanner at City Clinic

Clinical profileHEART & VASCULAR CENTER

www.cityclinic.bg18

Additionally, the Imaging Department at City Clinic Sofia is the most advanced imaging unit in Eastern Europe. It has a cutting edge 3T MRI wide-bore scanner, a 128-slice CT scanner, digital X-ray and fluoroscopy machine, digital mammography machine, a series of latest models ultrasounds and a state-of-the-art picture archiving and communications system (PACS).

Medical Technology Employed at City Clinic Sofia

City Clinic

Clinical profileMEDICAL TECHNOLOGY IN DIAGNOSTIC IMAGING

www.cityclinic.bg19

Outpatient Clinics

The Diagnostic Consultative Center offers a full range of outpatient medical specialties for initial and consultative medical exams. Moreover, it is directly connected to the inpatient departments to ensure rapid hospital admittance and streamlined communication among the medical teams

There are 14 outpatient clinics covering a broad spectrum of outpatient care:

− Gastroenterology

− Cardiology

− Endocrinology

− Pulmonary Diseases

− Neurology

− General surgery

− Urology

− Cardio-vascular surgery

− Gynecology

− Prenatal care

− Eye Diseases

− Pediatrics

− Vascular Medicine

− ENT

Exam Room at City ClinicClinical profileOUTPATIENT CENTER

www.cityclinic.bg20

More than 55,300 outpatient visits were done in 2014 and more than 6,600 patients were admitted for hospital treatment.

The cardiovascular medicine department treats annually above 4,000 of which around 3,900 interventions were performed.

More than 700 heart surgeries were performed

More than 650 vascular surgeries of any type were performed including nearly 300 aortic surgeries.

More than 1000 endoscopy procedures were performed.

About 100 stroke patients received treatment at City Clinic Sofia hospital.

Delivered services for 2014

Key figures

Indicator Number

Number of Outpatient Visits ~44 200

Outpatient Imaging Examinations ~11 100

Number of Inpatient Admissions, of which ~6 600

Cardiology and Vascular Medicine ~3 900

Cardiac Surgery ~700

Vascular Surgery ~650

Internal Diseases ~1050

Neurology ~250

www.cityclinic.bg21

The only hospital in Bulgaria and in the region that covered the highest standards in healthcare qualityand patient safety and thus received accreditation by Joint Commission International (JCI)

One of the only 650 hospitals worldwide that meet the so called “Gold Standard” for healthcare quality and safety

Constant focus on systematic improvements in ourperformance and patient care

Certificate for JCI Accreditation Quality and Patient SafetyACCREDITATION

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Hospital rooms

Modern equipped rooms in warm and restful environment including:

Hospital room upgrades

− Standard 2 or 3 person room

− Private VIP room

Separated restrooms equipped with luxury hygienic facilities

Individual internet and TV access

Constant connection to the Doctors and Nurses via intercom

Option for a loved one to stay in the same room with the patient

Comfortable beds with self-adjusting regulating mechanism

Patient Accommodation Premium Inpatient Facilities

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Medical tourism

City Clinic has dedicated personnel, who coordinate medical care for all international patients. Professional care coordinators are familiar with patients’ cultural expectations and trained to interpretthe latter in a medical setting.

We assist our international patients with:

patient’s visit;

scheduling appointments;

arranging hospital admission and an interpreter;

hospital admissions and financial transactions;

arranging medical transportation pick-up and drop-off, transfers, etc.

accommodation alternatives and transportation.

Our center is designed to help the international patients to derive maximum benefit during their stay at the hospital. An international patient coordinatorsguide the patient throughout the entire process and handles all the details, thus allowing the patient and his family to concentrate on healing.

Patient Accommodation International Patients and Medical TouristsASSISTANCE SERVICE CENTER

www.cityclinic.bg24

Call Center: +359 700 13 127

International Patient Center: +359 2 960 4915

E-mail: office@cityclinic.bg

Website: www.cityclinic.bg

Contact Information