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Angina Pectoris (heart Attack) — Coronary Bypass Surgery (cabg): treatment in the Best Hospitals in the World

University Hospital Essen

9.6/10
location_onGermany, Essen

Department of Cardiothoracic Surgery

According to the Focus magazine, the Department of Cardiothoracic Surgery ranks among the top German medical facilities specializing in the surgical treatment of diseases of the cardiovascular system and lung cancer! The department offers the full range of surgical services for the treatment of diseases of the cardiovascular system, respiratory tract, including heart and lung transplantation, artificial heart implantation. The therapeutic options include aortic surgery, coronary artery bypass grafting, transplantation surgery, surgical treatment of heart rhythm disorders (arrhythmias), minimally invasive surgery, surgical treatment of the heart valves, including reconstructive interventions. All operations are performed using state-of-the-art technology and in accordance with the current recommendations of professional societies.

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University Hospital Oldenburg

10/10
location_onGermany, Oldenburg

Department of Cardiac Surgery

According to the Focus magazine, the Department of Cardiac Surgery ranks among the top German medical facilities specializing in the surgical treatment of diseases of the cardiovascular system! The department offers the full range of services in this ​​medical field. Many heart surgeries are performed using minimally invasive technique, which has a positive effect on the healing of an operative wound. The patient also experiences less pain and the hospitalization period is significantly reduced. Thanks to long experience of doctors and modern equipment, the department provides excellent results in the treatment of heart pathologies.

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University Hospital Ulm

8.7/10
location_onGermany, Ulm

Department of Cardiothoracic Surgery

The Department of Cardiothoracic Surgery offers the full range of surgical treatment of diseases of the heart, lungs, thoracic organs and blood vessels. Medical care is provided 24 hours a day. The doctors of the department prefer an individual approach to each patient and take into account all his needs and wishes. In clinical practice, doctors apply both classic and innovative surgical techniques in order to achieve the best therapeutic results.

University Hospital Frankfurt am Main

10/10
location_onGermany, Frankfurt am Main

Department of Cardiothoracic Surgery

According to the Focus magazine, the Department of Cardiothoracic Surgery ranks among the top German medical institutions specializing in the surgical treatment of heart diseases! The department offers the full range of first-class medical care for patients with diseases of the heart and thoracic organs that require surgical treatment. The availability in the department of advanced technical base allows for the most sparing treatment and minimally invasive surgery. The main focuses of clinical practice include coronary artery bypass grafting, modern procedures for heart valve reconstruction and replacement, treatment of diseases of the thoracic aorta, as well as treatment of heart failure by implanting an artificial heart.

University Hospital Tuebingen

9.2/10
location_onGermany, Tuebingen

Department of Adult and Pediatric Cardiothoracic Surgery

According to the Focus magazine, the Department of Adult and Pediatric Cardiothoracic Surgery is included in the ranking of the top German departments specializing in the surgical treatment of cardiovascular diseases! The department offers the full range of treatment of various diseases of the heart, blood vessels, organs of the respiratory system in adults and children. As part of the German Heart Competence Centre Tuebingen, the department is distinguished by the outstanding quality of medical care, competent specialists, as well as high-tech equipment of the latest generation.

University Hospital Erlangen

9.1/10
location_onGermany, Erlangen

Department of Cardiac Surgery and Heart Transplantation

According to the Focus magazine, the Department of Cardiac Surgery and Heart Transplantation ranks among the top German departments specializing in heart interventions! The department offers the full range of surgical treatment for cardiac pathologies of varying severity. A large number of the operations performed in the department are coronary artery bypass grafting and heart valve interventions, which are most often performed using minimally invasive techniques. The team of the department's surgeons is proud of their high success rates in surgical treatment and the prestigious quality certificates of the German Cardiac Society in the field of transcatheter aortic valve implantation (TAVI) and heart failure treatment. In addition, the medical facility enjoys the status of one of the best in the international medical arena for heart transplantation and the implantation of mechanical hemodynamic heart support systems. The department provides medical care in accordance with the very latest standards and offers the highest possible safety for patients. The surgical treatment is accurately planned and, if possible, operations are performed using sparing surgical techniques, without thoracotomy.

University Hospital RWTH Aachen

9.5/10
location_onGermany, Aachen

Department of Cardiothoracic Surgery

According to the Focus magazine, the Department of Cardiothoracic Surgery ranks among the top medical facilities in the field of its ​​specialization! The department offers all options of modern surgery for the treatment of diseases of the cardiovascular system and thoracic organs. The department widely uses modern minimally invasive techniques, which are considered the gold standard of surgery. Since its founding in 1976, the department has performed more than 40,000 open heart interventions. The department's surgeons also have vast experience in the field of implantation of the artificial heart and mechanical heart support systems. All operations are carried out in strict accordance with the protocols of professional societies.

University Hospital Würzburg

9.2/10
location_onGermany, Würzburg

Department of Adult and Pediatric Cardiothoracic Surgery

According to the Focus magazine, the Department of Adult and Pediatric Cardiothoracic Surgery is included in the ranking of the top departments in Germany specializing in the surgical treatment of diseases of the cardiovascular system! The department offers the surgical treatment of all congenital and acquired heart diseases in adulthood, including heart transplantation, as well as the treatment of respiratory diseases in adults and children. It performs more than 2,000 interventions on the heart and about 600 operations on the lungs every year.

University Hospital Heidelberg

9.8/10
location_onGermany, Heidelberg

Department of Cardiac Surgery

According to the Focus magazine, the Department of Cardiac Surgery ranks among the top German departments specializing in cardiac surgery! The department offers the full range of surgical interventions for the treatment of cardiac pathologies. The main priorities of the department include aortic surgery, heart transplantation, minimally invasive bypass grafting and heart valve surgery. It performs more than 2,500 surgical interventions every year. In especially complex clinical cases, all necessary specialists from the related fields are involved.

University Hospital Bonn

9.2/10
location_onGermany, Bonn

Department of Cardiac Surgery

According to the Focus magazine, the Department of Cardiac Surgery ranks among the top German departments specializing in the surgical treatment of heart diseases! The department offers the full range of modern surgical interventions for the treatment of diseases of the heart, coronary vessels and thoracic aorta (with the exception of transplantation of the thoracic organs). An excellently trained team of specialists and state-of-the-art technologies guarantee the best medical care adapted to the individual needs and wishes of patients.

University Hospital Jena

8.9/10
location_onGermany, Jena

Department of Cardiothoracic Surgery

According to the Focus magazine, the Department of Cardiothoracic Surgery ranks among the top medical facilities of this kind in Germany! The department offers the full range of surgical treatment of diseases of the cardiovascular system and thoracic organs in adults. Of particular interest is sparing minimally invasive surgery, particularly, heart valve interventions and coronary artery bypass grafting. Such interventions are carried out using the innovative da Vinci surgical system. The video-assisted thoracic surgical methods are widely used in the surgical treatment of thoracic diseases as well. All the department's specialists have excellent qualifications and vast clinical experience, which in combination with the cutting-edge technologies allows doctors to achieve the outstanding treatment results.

University Hospital Halle (Saale)

9.6/10
location_onGermany, Halle

Department of Cardiothoracic Surgery

The Department of Cardiothoracic Surgery covers the entire range of top-class medical services in this field. Special attention is paid to minimally invasive operations, which, along with the optimal functional result, ensure minimal traumatization, fast recovery and the absence of a cosmetic defect. The optimal type of therapy is selected in collaboration with the specialists from all the necessary related disciplines and adapts to the specific clinical indications of the patient.

University Hospital of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Cardiac Surgery

According to the Focus magazine, the Department of Cardiac Surgery ranks among the top departments in Germany in the area of its specialization! The department offers the full range of services in the field of diagnostics and treatment of heart diseases. It performs more than 2,500 operations every year, including minimally invasive ones. The highly qualified team of doctors and nursing staff, whose main task is to provide optimal treatment based on the very latest achievements of modern medicine, take care of the patients.

Charite University Hospital Berlin

9/10
location_onGermany, Berlin

Department of Cardiac Surgery

According to the Focus magazine, the Department of Cardiac Surgery ranks among the top German medical facilities specializing in the surgical treatment of cardiovascular diseases! The department offers the full service range in the field of cardiac surgery. Despite the fact that the department has long traditions, it has the reputation of one of the most high-tech Cardiology Centers in Europe. The clinical practice involves the use of achievements of modern surgery, particularly, minimally invasive and catheter techniques. Thus, cardiac surgeons achieve excellent results and at the same time guarantee the most sparing treatment and fast recovery for the patient.

University Hospital Duesseldorf

9.5/10
location_onGermany, Duesseldorf

Department of Adult and Pediatric Cardiothoracic Surgery

According to the Focus magazine, the Department of Adult and Pediatric Cardiothoracic Surgery ranks among the top German departments specializing in the surgical treatment of diseases of the cardiovascular system! The department offers the full range of surgical treatment of diseases of the heart, lungs, and other thoracic organs. The department has a long and successful history. It has performed more than 50,000 heart surgeries since 1938. The first open-heart surgery under hypothermia, the first heart valve replacement surgery, as well as the first pacemaker and cardioverter-defibrillator implantations in Germany should be mentioned among the department’s achievements.

University Hospital Muenster

9.8/10
location_onGermany, Muenster

Department of Congenital and Acquired Heart Defects, Heart Valve Diseases

The Department of Congenital and Acquired Heart Defects, Heart Valve Diseases offers the full range of diagnostics, outpatient and inpatient treatment of these diseases. The department became the first Center of Excellence in Germany in the field of its specialization and annually treats a large number of native patients and patients from other countries of the world. The department has a wide range of diagnostic options, as well as doctors have vast experience in catheter interventions. The department's medical team makes every effort in order to provide the first-class medical care adapted to individual needs. At the same time, important attention is paid to the psychosocial support of patients.

Angina pectoris is not an independent pathology, but a syndrome by the means of which the coronary heart disease manifests. Angina pectoris (heart attack) is a kind of signal that the oxygen supply is not enough, and it shows by the episodes of sudden sharp squeezing and pressing discomfort. It is often accompanied by general discomfort, dyspnea, and heart palpitations.

Content

  1. What causes angina pectoris and how it is treated
  2. Symptoms and diagnosis of angina pectoris
  3. Coronary bypass surgery overview
  4. Contraindications for coronary artery bypass surgery
  5. Is there an alternative to CABG?
  6. Rehabilitation after CABG
  7. Where to undergo coronary bypass surgery?
  8. How much does treatment with CABG cost?
  9. How to undergo treatment abroad?

What causes angina pectoris and how it is treated

 

The major process that facilitates the development of angina pectoris (heart attack) is plaque formation in the coronary arteries. Cholesterol along with other substances accumulates on the walls of the vessels, causing the buildup. The plaques narrow the lumen of the vessels, reducing the amount of blood carried away from the heart.

Since at rest the need for oxygen is minimal, blood flow through affected vessels is enough. When a person is physically or emotionally stressed, the heart needs much more oxygen, but the narrowing in arteries creates an oxygen starvation. If pain sensation suddenly appears at rest, it usually indicates a sharp blood flow in the coronary arteries, or thrombosis. This condition is called unstable angina pectoris.

Symptoms and diagnosis of angina pectoris

 

Angina pectoris can often be identified at the first visit of the patient, whereas to reject the diagnosis, observation of the course and analysis of data from repeated inquiries and examinations are necessary. The following signs complement the clinical picture of angina, but their absence does not exclude the diagnosis:

  • Localization of pain is behind the sternum (may recur in the neck area, in the lower jaw, and teeth, in the arm, usually the left, in the shoulder and scapula).
  • Pain implies pressing, squeezing, less often burning body sensation in the chest (sometimes the patient may not experience pain, but a heavy sensation behind the chest).
  • Increase in blood pressure simultaneous with the period of heart attack, pallor, sweating, and pulse rate fluctuations.

The thoroughness of questioning determines the timeliness and correctness of establishing the diagnosis. It often happens that the patient experiencing typical sensations for angina does not inform the doctor about them as "not related", or, on the contrary, pays attention to diagnostically minor sensations, which complicates the diagnosis.

Coronary bypass surgery overview

 

Currently, CABG is an efficient, yet complex and expensive treatment technique. The patients who underwent CABG, in comparison to drug therapy, showed better clinical results during perioperative period and 3-year follow-up.

During coronary artery bypass grafting, the patient's own veins and arteries are used as "new" vessels. Those are usually located in the extremities and front chest wall. They are replaced and fixed to the heart arteries below the places of blockage.

There are several ways to perform coronary artery bypass grafting (CABG). Heart bypass surgery can be conventional, off-pump and minimally invasive. The decision about the type of coronary artery bypass surgery is made after coronarography and expert evaluation of the degree of the damage to the vessels.

In the case of conventional coronary bypass surgery, a surgeon assesses the heart through the chest incision that goes along the midline of the sternum. The other incisions are often made on the legs, where surgeons usually take a vein for surgery from.

The fact is that vessels in the legs are relatively not affected by various heart conditions. In addition, they are larger and longer than other veins available for use in coronary bypass surgery. Finally, after taking a section of the vein from the leg, there are usually no problems later on.

People who have had a coronary artery bypass surgery by no means should stop taking prescribed medications. Most medications that are prescribed today after coronary artery bypass surgery are vital. In order to reduce the risk of clotting, it is often necessary to take medications that reduce its probability.

Contraindications for coronary artery bypass surgery

 

Contraindications to this intervention traditionally are diffuse spreading of pathology, detected aortic aneurysm, and clinical signs of congestive heart failure.

There are also contraindications regarding a general health condition in the form of severe comorbidities, in particular, chronic nonspecific lung diseases, renal failure, and cancer, all of which are relative. Advanced age is also not an absolute contraindication for coronary artery bypass surgery; surgeons refer more to risk factors of potentially conducted CABG in this case.

Is there an alternative to CABG?

 

Coronary angioplasty and stenting, which are alternative methods of angina treatment, are interventions aimed at dilating clogged blood vessels. The term "angioplasty" itself implies the procedure, during which a balloon to open vessels is applied. However, in modern angina treatment tactics in Europe, stenting can also be used along with angioplasty. The stent stays in the vessel and enables unimpaired blood flow.

The essence of angioplasty is that a catheter with a balloon connected to it, specially selected for its length and diameter, is inserted into the area of clogging. The balloon inflates once the catheter reaches the narrowed (damaged or unhealthy) area of the artery. The inflating balloon constricts the artery and frees the artery from the blockage, thereby enabling normal blood flow. By inflating it under pressure, constriction is possible to be eliminated in 96% of cases. After that, most patients forget about angina for many years. Then a stent is implanted into the area that was just treated and unobstructed after. This procedure is called stenting of the heart vessels.

A special type of X-ray helps the surgeon more accurately assess the extent of damage to the vessel, exactly where the blockage in the coronary artery is located and show how the contrast agent passes through the arteries.

Stenting can be either planned or performed as an emergency.

As the name implies, "emergency" stenting is performed in critical conditions when a coronary artery narrowing or occlusion must be repaired as quickly as possible to either keep your heart from infarction or limit the area of the infarction if it develops. And the earlier and more fully the blood flow through the arteries of the heart is restored in such a patient, the better the chances of an uncomplicated and favorable course of cardiac rehabilitation.

Scheduled stenting has the advantage of a longer time frame to adequately assess the nature of coronary artery lesions, choose the best treatment tactics for the patient, and carefully prepare the patient for the stenting procedure, minimizing the risks of the intervention.

Balloon angioplasty is currently not used in isolation. The procedure can be used both before stenting to prepare the lesion for stent implantation, and after it, for a tighter fit of the stent to the vessel wall in case of anatomical features of the artery in the place of stenting.

Rehabilitation after angioplasty and coronary stenting is similar in its basic principles to the rehabilitation after other surgical and non-surgical methods of angina pectoris treatment.

Rehabilitation after CABG

 

Immediately after the surgeon has performed coronary bypass surgery, the patient stays in the cardiac intensive care unit for several days and then is transferred to the cardiac surgical unit. The treatment in the postoperative period takes from one to two weeks, gradually passing to the recovery stage. Rehabilitation usually continues in a specialized medical facility, where a favorable regimen of physical activities is created to gradually train the heart. Rehabilitation involves the use of physical therapy and therapeutic exercises to restore general state of health. Recovery after surgery usually takes a month, rarely more.

The common outcome of coronary artery bypass grafting (CABG), and for those for whom it is contraindicated, of angioplasty, is the absence of angina, the ability to handle gradually increasing volume of modified physical activity, and the ability to work again. Coronary bypass surgery reduces the chances of potential heart attack and decreases the number and dosages of medications to a minimum, as proven by numerous scientific studies.

For all of the mentioned alleviating factors to reach their maximum potential, a major aspect influencing the successful aftereffect from coronary artery bypass surgery should be taken into consideration, which is a compliance with all of the doctor’s recommendations in the postoperative period, which may regard taking medications, usually selected prior to surgery (a combination of drugs necessary to prevent thrombosis and stabilization of atherosclerotic plaques).

Where to undergo coronary bypass surgery?

 

Coronary artery bypass surgery is the most prevalent technique held for the treatment of heart attack. Hundreds of thousands of people successfully undergo this operation every year. Timely coronary bypass surgery prevents the chances of recurrent heart attack and the probability of other coronary artery diseases.

There is a reason why so many people undergo this surgery abroad. The procedure lasts several hours minimum and does require sufficient experience from a surgeon. CABG performed with the use of spearing surgical techniques, ultra-precise robotics and special video imaging requires special training from the surgeon as well. Taking into consideration that coronary bypass surgery is the widespread heart surgery conducted abroad, the level of expertise of the specialists in hospitals abroad does not cause any doubt.

The best hospitals for coronary artery bypass grafting are considered to be:

  • University Hospital Oldenburg, Germany.
  • University Hospital of Ludwig Maximilian University of Munich, Germany.
  • Assuta Hospital Tel Aviv, Israel.
  • HELIOS Heart Surgery Clinic Karlsruhe, Germany.

An overview regarding the conditions of stay in the mentioned hospitals is available on the Booking Health website.

How much does treatment with CABG cost?

 

Many people experiencing the health condition require planned or emergency coronary artery bypass surgery, and they usually wonder what is the price for it.

Coronary bypass surgery fits in the category of expensive high-tech methods of medical care, accordingly, the cost of treatment with coronary artery bypass surgery in the reputable cardiac hospitals cannot be referred to as low, although it may vary depending on the complexity of the operation for a particular patient and the services that the patient is provided after the heart surgery.

The typical prices for heart surgery are presented below:

  • The cost of treatment with CABG in German hospitals starts at 20,600 EUR.
  • The cost of treatment with CABG in Turkey starts at 14, 988 EUR.
  • The cost of treatment with CABG in Israel starts at 32,835 EUR.

How to undergo treatment abroad?

 

You could organize treatment with coronary artery bypass procedure yourself, but it is far more convenient to entrust experts with it. The preparation of the necessary documents, visa application, setting up the flight tickets, and transfer will be arranged for you by Booking Health.

Booking Health specialists will also find the most suitable hospital and the best doctors in the field for the treatment of heart attack for you. Booking Health does everything necessary to provide the trip and treatment of heart attack of the highest level at a loyal price, and for the stay at the hospital to be the most comfortable for you.

The amazing thing is that if you are only interested in coronary artery bypass graft (CABG) abroad at this point, Booking Health will provide you with reliable information for free, as the primary focus of the company is transparency.

Fill in the request form on the Booking Health website to get a consultation or to start your treatment.

Authors: Dr. Nadezhda IvanisovaDr. Farrukh Ahmed




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