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Subclavian Flap Aortoplasty for Aortic Coarctation treatment in Germany

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 directly29420.75
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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 directly24892.36
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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 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 malformations of the cardiovascular system. This disease cannot be cured with medicines, but the condition can be successfully managed using surgical techniques. Doctors perform several types of heart surgery, including subclavian flap aortoplasty. This treatment option is used in young children because it retains the potential for the narrowed aorta to grow as the patient ages. You can undergo your treatment in Germany and expect good results.

When being treated in German hospitals, you will benefit from top-class medical services. Doctors in this country use the latest treatment methods and modern medicines, and patients receive quality care. You can make an appointment for your treatment in Germany through the Booking Health service. Our website presents the cost of treatment in Germany using various procedures and surgical interventions. You can also compare prices and choose a medical care program in one of the German hospitals. The specialists at the Booking Health company will provide you with services for organizing your trip abroad.

Content

  1. When can subclavian flap aortoplasty be used?
  2. The essence of treatment using subclavian flap aortoplasty
  3. How is subclavian flap aortoplasty performed for aortic coarctation?
  4. Advantages and disadvantages of subclavian flap aortoplasty for aortic coarctation
  5. Results of treatment in Germany for aortic coarctation

When can subclavian flap aortoplasty be used?

 

Flap aortoplasty is one of the many treatment options for aortic coarctation. A narrowing of the primary aorta can be addressed in a number of ways, including:

  • subclavian flap aortoplasty;
  • synthetic patch aortoplasty;
  • resection with end-to-end anastomosis; 
  • resection with end-to-side anastomosis; 
  • extended resection with aortic prosthetic repair; 
  • interposition graft shunting;
  • balloon angioplasty (a minimally invasive procedure). 

The choice of options for treating aortic coarctation depends on the patient's age and the anatomical type of the defect (localization, degree, and length of narrowing). In infants, the two main surgical procedures for treating aortic coarctation are coarctation resection with end-to-end anastomosis and subclavian flap aortoplasty. End-to-end anastomosis is the most common option. Nonetheless, when the coarctation is large, doctors may prefer subclavian flap aortoplasty.

The essence of treatment using subclavian flap aortoplasty

 

The first successful treatment of aortic coarctation was in 1944, when Crafoord performed removal of the narrowed section with an end-to-end anastomosis. Since then, despite the emergence of many other types of cardiac surgery, this technique has remained the main treatment method.

In 1966, Waldhausen and Narhwold described a new surgical technique, namely subclavian flap aortoplasty. When performing this operation, the left subclavian artery is ligated distally and turned downward as an autologous flap that passes through the coarctation area. It was expected that the technique would be used as an alternative treatment option for patients in whom end-to-end anastomosis is not possible or would result in severe aortic tension due to the large length of the coarctation zone.

How is subclavian flap aortoplasty performed for aortic coarctation?

 

Surgeons perform a surgical procedure using open techniques under general anesthesia. Doctors perform a left-sided thoracotomy. An incision is made in the fourth intercostal space on the left. The arch, descending aorta, arterial duct, and left subclavian artery can be approached in this way.

Doctors ligate the vertebral artery and the left subclavian artery. The duct is ligated, the aorta is clamped, and the subclavian artery is traversed at its point of origin from the vertebral artery. A longitudinal incision is then made from the distal aorta, through the coarctation zone, and along the length of the subclavian artery. Pathologically altered tissues are excised inside. The subclavian flap is turned down and secured with a suture.

Advantages and disadvantages of subclavian flap aortoplasty for aortic coarctation

 

The main advantage of using a flap of the patient's own subclavian artery for plastic surgery to treat coarctation is the preservation of the growth potential of the aorta. The subclavian flap becomes part of the aortic tissue after surgery, and it also grows, which would not be possible with a synthetic patch.

End-to-end anastomosis also impairs aortic growth, although to a lesser extent. During this operation, doctors apply circumferential sutures. As a result, a scar may appear in this area, which is less elastic. As the child grows, this zone may remain narrow. When performing subclavian flap aortoplasty, such problems do not arise.

Other advantages of this heart defect repair option include the following:

  • plastic surgery is performed without any tension; 
  • high efficiency in the case of a significant length of coarctation;
  • there is no need to open and remove a significant part of the aorta. 

But there are also disadvantages. The duct tissue remains in the same place, so the recurrence rate of aortic coarctation is higher than after resection with end-to-end anastomosis. The absence of recurrent aortic coarctation within 5 years using these two methods is 89% versus 95%. End-to-end anastomosis is therefore used more often than subclavian flap aortoplasty.

In addition, following subclavian flap aortoplasty, blood supply to the left arm is disrupted in 3% of patients, which may lead to a limb length discrepancy. Despite this, functional defects usually do not develop.

In the 20th century, flap repair in heart surgery was very common. But in the 21st century, the trends are such that this operation is gradually becoming a thing of the past. Increasingly, doctors are opting for other surgical options. According to O'Brien, who analyzed data from 77,294 operations for coarctation of the aorta, it turned out that resection with end-to-end anastomosis accounts for 40% of all interventions, while cardiac surgeons prefer to perform subclavian flap aortoplasty in only 5% of cases.

Results of treatment in Germany for aortic coarctation

 

The outcomes of subclavian flap aortoplasty for isolated aortic coarctation are good because the 10-year survival rate of patients with this heart disease is close to 100%. Most of them completely normalize their hemodynamics, and in the near future they will not need any medicines or repeated cardiac operations.

The results are much worse when aortic coarctation is combined with severe malformations of the cardiovascular system. These patients have a 10-year survival rate of 62%. It can be difficult to completely correct their hemodynamics. Therefore, over time, repeated heart operations may be required and heart failure may develop.

The incidence of arterial hypertension in adulthood following subclavian flap aortoplasty for aortic coarctation is estimated by different authors to range from 20 to 40%. The condition has to be constantly monitored with medicines. Without taking medicines, hypertension may lead to other cardiovascular diseases over time.

You are welcome to visit the Booking Health website to find out the cost of treatment in Germany and to get medical services in one of the German hospitals at the best price. The website presents the best German hospitals that specialize in the treatment of aortic coarctation and other diseases of the cardiovascular system. When having your treatment in Germany, you will receive top-class medical services.

When you make your appointment through Booking Health, the cost of treatment in Germany will be lower for you than when you contact the medical center directly. The reduction in prices for services is due to the absence of taxes for foreign patients. After the start of your program, the cost of treatment in Germany will not increase, even if additional medical services are required, as you will receive insurance that will cover expenses not covered by your program. The specialists at the Booking Health company will provide you with services for organizing your trip abroad. After the completion of your treatment, we will help you receive remote medical consultations within 3 months. Whenever required, we will take care of forwarding medicines from Germany to your native country.

 

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:

National Library of Medicine

ECR - European Cardiology Review

PubMed




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