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Bypass Graft Repair for Aortic Coarctation

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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Hospital directly29342.89
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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.

Hospital directly24767.08
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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

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 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 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 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 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 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.

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 of Ludwig Maximilian University of Munich

10/10
location_onGermany, Munich

Department of Adult and Pediatric Cardiac Surgery

The Department of Adult and Pediatric Cardiac Surgery offers all the possibilities of modern surgery for treating heart disease, including a heart transplant. The department's team of surgeons admits both adult patients and children. The department annually performs more than 3,500 operations, including minimally invasive ones. The most common diseases in the clinical practice of cardiac surgeons include heart failure, coronary artery disease, heart arrhythmias, and heart valve and aortic pathologies. The department's operating rooms have all the resources for efficient and safe heart surgery. The patients' health is in the safe hands of a highly qualified team of doctors and nursing staff, numbering more than 155 employees. The main task of surgeons is to provide an optimal treatment based on the very latest advances in modern medicine. At the same time, the specialists always show a humane attitude towards a patient, considering his individual needs and wishes.

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.

Aortic coarctation is one of the most common heart defects, accounting for up to 7% of all cases. The disease is often severe, causing critical hemodynamic disorders in patients shortly after birth. If hemodynamic compensation occurs, severe complications will develop after the age of 20-30 years. Every case of coarctation of the aorta requires treatment to restore normal circulation. The earlier it is performed, the better the results. You are welcome to use the Booking Health service to undergo your treatment abroad or find out the cost of treatment at a hospital abroad. On our website, you can compare prices at different hospitals and get services for organizing your trip to a foreign hospital.

Content

  1. What is aortic coarctation?
  2. What is a bypass graft repair for aortic coarctation?
  3. When can a bypass graft repair for aortic coarctation be performed?
  4. How is a bypass graft repair for aortic coarctation performed?
  5. Benefits of a bypass graft repair for hemodynamic restoration in aortic coarctation
  6. Where to undergo your aortic coarctation treatment?

What is aortic coarctation?

 

Coarctation of the aorta is the narrowing of this blood vessel. This can be localized anywhere but is most often found in the ductus arteriosus.

The disease is characterized by severely impaired hemodynamics, since too little blood passes through the narrowed section of the aorta into the systemic circulation. Over time, a partial recovery of hemodynamics occurs due to the expansion of coronary collaterals, which are bypass routes for blood flow. However, comprehensive recovery does not occur, so all patients with coarctation, without exception, need surgery.

If left untreated, coarctation causes severe complications. These may be ventricular dysfunction, brain aneurysms, severe arterial hypertension, or early coronary heart disease.

What is a bypass graft repair for aortic coarctation?

 

Bypass grafting is an operation to form a bypass, which is an additional blood vessel through which blood flows around the area of narrowing of the aorta. Doctors perform blood vessel grafting from another part of the body. During the grafting procedure, the blood vessel is fixed above the narrowing with one end and below the narrowing with the other.

At hospitals abroad, such a grafting procedure can be performed without the use of a heart-lung machine. During the bypass graft repair, it also does not matter what condition the aorta and its arch are in or whether there are adhesions in the thoracic cavity because the operation can still be performed successfully.

A bypass graft repair was first performed in 1973. The technique was developed to reduce the risk of complications. This surgery is indeed one of the safest for a patient. In the original version of the surgical intervention for the treatment of coarctation, the bypass started from the aortic arch and flowed into the descending aorta. This bypass graft repair is called an aorto-aortic bypass.

Based on the results of the blood vessel grafting and the formation of an aorto-aortic bypass, complete hemodynamic recovery occurs. After recovery, patients can lead a full and active life without any restrictions. The quality of life increases and its duration increases due to the prevention of complications of aortic coarctation and improved control of arterial hypertension.

When can a bypass graft repair for aortic coarctation be performed?

 

A bypass graft repair to restore hemodynamics is not very common in hospitals abroad. Basically, this operation is performed on adult patients with coarctation.

Bypass grafting is not one of the main methods of restoring hemodynamics in patients with aortic coarctation. Doctors at most hospitals prefer to perform end-to-end anastomosis, aortic replacement surgery, or balloon angioplasty with stenting. However, in some cases, an aorto-aortic bypass is still used. Basically, blood vessel grafting to form a bypass blood flow path is performed in the following cases:

Recurrent coarctations of the aorta. If a patient has previously undergone surgical treatment but has experienced recurrent blood vessel narrowing, a bypass graft repair is performed. 

Adhesions at the site of the surgical intervention. Adhesions may develop both after operations for heart defects and after any other surgical interventions. They interfere with the necessary manipulations. Therefore, in such a case, an aorto-aortic bypass is a technically simpler solution to restore blood flow, as well as more successful.

An atypical localization of the narrowed site. For example, if the coarctation area is located in the descending thoracic aorta or in the abdominal aorta.

A rather long length of the narrowed site. A bypass graft repair may be performed as an alternative to an aortic prosthetic repair. However, prosthetic repair surgery is more common.

A high risk of brain damage. A bypass graft repair can be performed without clamping the carotid arteries or using a heart-lung machine. Therefore, the technique is suitable for the treatment of patients in whom prolonged depletion of the cerebral blood flow is unacceptable due to the high risk of cerebral complications.

How is a bypass graft repair for aortic coarctation performed?

 

The operation is performed using open techniques. Surgical approaches may be different. Surgeons may make an incision in the center of the chest, on the lateral surface of the chest on the left, or on the right. Most often, a right-sided thoracotomy is performed when an incision is made between the ribs on the right.

A bypass graft repair may be performed with or without the use of a heart-lung machine. In general, surgeons prefer to perform the operation without connecting a patient to the heart-lung machine to reduce the risk of complications. The possibility of avoiding its use is one of the main advantages of bypass grafting as compared to other operations for aortic coarctation repair.

The incision is usually made in the fifth intercostal space. A doctor opens the pleura, retracts the lung upward and anteriorly, and highlights a segment of the aorta about 10 centimeters long. The right intercostal arteries are ligated. Doctors implant the lower end of the vascular prosthesis and check its tightness. The lung is then retracted down and back, the pericardium (pericardial sac) is dissected, the ascending aorta is isolated, and the upper part of the graft is placed.

Upon completion of the operation, the clamps are removed, and blood flow in the aorta is restored. Doctors close a surgical wound by suturing it. For several days, tubes remain in the wound to drain fluid from the pleural and pericardial cavities.

Benefits of a bypass graft repair for hemodynamic restoration in aortic coarctation

 

The bypass grafting technique is less common as compared to other hemodynamic restoration surgeries for aortic coarctation. However, it has benefits that allow this treatment option to remain in the arsenal of surgeons for half a century. The main ones are:

  • because aortic parietal pressing is not required, cerebral circulation is not impaired (there is a low risk of neurological disorders after surgery);
  • the aorta is not dissected in the area of degeneratively altered walls;
  • there is not even a minimal likelihood of some complications that are inherent in other types of operations, such as damage to the recurrent laryngeal nerve, intercostal arteries, or lungs;
  • the absence of complications from the spinal cord;
  • the operation can be performed without the use of a heart-lung machine, so complications associated with its use (systemic inflammation or damage to blood cells) do not develop;
  • a less traumatic surgical approach shortens patients' recovery time and makes the postoperative period easier;
  • during a bypass graft repair to restore blood flow in coarctation, simultaneous release of the esophagus and trachea in the case of their compression can be performed, if required.

Where to undergo your aortic coarctation treatment?

 

You can undergo your treatment abroad. There are a few reasons for you to go abroad. These are the following:

  • in developed countries, operations for aortic coarctation are effective and safe;
  • hospitals abroad have state-of-the-art equipment;
  • doctors use the latest modifications of surgeries;
  • operations are performed through minimally traumatic surgical approaches and without a heart-lung machine;
  • successful interventions are performed even in complex cases: in significant degenerative changes in the aorta, concomitant aortic arch hypoplasia, adhesions in the chest cavity, and secondary pathologies of the cardiovascular system;
  • after the operation, you will be able to undergo full rehabilitation to return to your normal life in a short time.

You are welcome to use the Booking Health service to undergo your treatment abroad. On our website, you can see the cost of treatment, compare prices, and choose a medical care program. When you make an appointment at the hospital through Booking Health, the cost of treatment abroad will be lower for you. Prices are reduced due to the absence of additional taxes for foreign patients. In addition, you can be sure that the initial cost of treatment will not increase after the start of your medical care program. You will receive insurance that will cover unexpected medical expenses.

The Booking Health specialists will organize your treatment abroad. We will contact the hospital administration, make an appointment on your preferred dates, translate and send your medical documents to the hospital, and book the nearest hotel and airline tickets. Our company's employees will meet you at the airport and take you to the hospital by car. After the completion of your treatment abroad and recovery, a return transfer from the hospital to the airport will be organized.

 

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

European Society of Cardiology

American College of Cardiology

Medscape




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