, Patient s Guide

German Heart Centre of the State of Bavaria and the Technical University Munich German Heart Centre Munich Lazarettstraße 36 Telephone +49 (0) 89 1218-0 80636 München Fax +49 (0) 89 1218-3053 Germany

Publisher German Heart Centre Munich

www.dhm.mhn.de [email protected]

Press Officer Robert Siegert

Design and Layout icom new media and design Ickstattstraße 16 80469 München

www.icom.de [email protected]

Photography DHM icom

4th edition June 2014

2 5 Welcome

8 Vision

10 How the heart works

14 Department of Cardio-Vascular Surgery

18 Department of Cardiac and Circulatory Diseases

Table of content 22 Department of Paediatric Cardiology and Congenital Heart Disease

26 Institute for Anaesthesiology

28 Institute for Laboratory Medicine

30 Institute for Radiology und Nuclear Medicine

32 Patient Care

34 The Hybird operating theatre

35 Definition Flash CT and Magnetom Avanto

36 Commercial Directorate

38 Total Quality Management (TQM) – a puzzle with nine pieces

40 Ronald McDonald House

41 Friends of the German Heart Centre Foundation

42 A-Z

47 Numbers of patients and procedures

48 How to reach us

50 Information on the Internet

51 Contact

3 The German Heart Centre Munich (Deutsches Herzzentrum München, DHM) has made history as a role model for first-class, patient-oriented medicine. This high-capacity hospital in the Lazarettstrasse in Munich has provided cutting-edge care for patients in the entire field of cardiovascular disease for 40 years. The concept of treating people of all ages with all forms of cardiological disease under a single roof has become well esta- blished, having since been applied to numerous other areas of medical specialisation over the decades.

Cardiovascular disease concerns us all. It is still the most frequent cause of death in industrialised nations. The number of people suffering from heart disease has been on the increase for years, creating a growing need for care provision. The German Heart Centre has performed an excellent service in this area ever since it was founded. offered by the DHM in the use of these German Centre for Cardiovascular new techniques. The DHM has set Research (DZHK) and as partner for Patients receive optimum care with standards in the area of electrophy- integrated research projects of the state-of-the-art diagnostics and siology, too, improving the mapping European Union. Thus medical progress therapy, as well as benefiting from of cardiac arrhythmia using magnetic and innovative treatment methods are close interdisciplinary cooperation navigation systems. A GPS-guided inseparably combined at this institution. between the departments. In the field mapping system has been deployed of cardiological imaging, for example, with great success since 2013 as part On this note, I wish the highly qualified the DHM uses the world‘s fastest and of a research project. and dedicated staff of the German lowest radiation CT scanner. Study Heart Centre Munich continued success, results fort he treatment of coronary Research into cardiovascular disease and I wish all patients a swift, successful artery disease and myocardial infarction is a key focus of the activities at the treatment. have influenced national and interna- DHM, which collaborates with Tech- tional guidelines. The DHM is also one nische Universität München (TUM) as Munich, April 2014 of Germany‘s leading specialist hospitals well as Klinikum rechts der Isar der in the deployment of transcatheter TUM. The DHM takes on key research heart valves. Clinics all over Germany assignments as an integral member now take part in the induction courses of the Munich Heart Alliance in the Dr. Ludwig Spaenle Bavarian Minister of Education, Science and the Arts

4 Welcome to the German Heart Centre Munich

The German Heart Centre Munich has gone down in history as a cardiovascular dis- optimal patient care through close inter- paragon for the consolidation of state of the art medical treat- ease at one facility disciplinary cooperation. The institution ment of cardiovascular diseases at one centralised location. has proved to be consists of the Department of Cardio- highly effective and Vascular Surgery; the Department of has become accep- Cardiac and Circulatory Diseases; the Since its foundation in 1974 as the first ted in other areas of medicine. Department of Paediatric Cardiology heart centre in Europe, the German The guiding principle of the hospital and Congenital Heart Disease as well as Heart Centre has served as a model is to consolidate at one location the the Institute for Laboratory Medicine; for other institutions numerous times. various medical branches required for the Institute for Anaesthesiology and The new medical concept of treating the diagnosis and treatment of cardi- the Institute for Radiology and Nuclear patients of all ages with all types of ovascular disorders, thus providing Medicine.

5 The name German Heart Centre Munich tion of the heart valves. If valve repair conventional surgery. Furthermore, the stands for world class medical excel- is not possible, there is a wide range clinic of cardiac and vascular surgery lence. The Centre has given many im- of options to select the suitable imp- specializes in all minimally invasive pulses to medical development. Since lant regarding the age and life-style of surgical techniques and operations its establishment, more than 400,000 the patient. The German Heart Center with small incisions. The advantage is patients have been treated on an out- Munich also runs a homograft bank. not only seen in the improved cos- patient basis and almost 200,000 were There is broad experience particu- metics for the patient, but also in a treated inpatient. 42,000 operations larly with regard to the treatment of positive effect on the healing process. with heart-lung machine have been extremely difficult cases. The cardiac Avoiding a 20-30cm long incision in performed. The first successful heart surgery department is equipped with the mid-sternum line, video-assisted transplantation in Germany was done the latest technology such as intra- mitral valve repair is performed through at the German Heart Centre Munich in operative blood flow measurement, a 5 to 6 cm incision on the right side of 1981. angiography, or 3D echocardiography. the chest. Aortic valve replacement can The clinic offers all types of heart New minimally invasive techniques also be performed minimally invasive surgery and surgery on the large blood are used whenever suitable. through a partial sternotomy with a vessels, including catheter-based Since June 2007, the German Heart 6-7cm incision. procedures. 96% of the patients re- Centre offers catheter-based valve Another main focus is surgery of congeni- ceiving coronary artery bypass surgery implantations that are via the femoral tal heart defects in children, adolescents are treated with arterial grafts which artery in the groin or the apex of the and adults. The German Heart Center have a significantly better long-term heart. Today, it is one of the world’s Munich is one of the world-wide leading patency than veinous grafts. The grafts largest “TAVI” centers offering less centers for pediatric surgery. All types for bypass surgery are usually removed invasive treatment of aquired valve of surgical correction of congenital heart endoscopically at the German Heart disease. All procedures are performed defects are offered. Complex congenital Center Munich. Concerning surgical on the beating heart without heart- heart defects are operated even in therapy of heart valve disease, special lung-machine and are optimal for infants weighing less than 2,000 grams. consideration is given to the preserva- elderly patients at increased risk for In cardiology, highly specialized doctors

6 perform diagnostics and treatment done catheter-interventional through operating room and a total of eight of a wide range of diseases, such as the groin. The dilation of constricted cardiac catheterization rooms. The five narrowed coronary artery vessels, blood vessels, the closure of connections intensive care units are on the latest calcified heart valves, and heart between the major arteries or between level of technology. DHM is considered rhythm disturbances. The heart centre the two atria or the two chambers are as a pilot project in the Free State of is considered as one of the leading now routine. The spectrum concerning Bavaria through its full digital X-ray centers in the world in the field of electrophysiology and intravascular technology as well as the installation interventional cardiology, the centre ultrasound has been extended through of screen network (PACS), digital used all kinds of modern stents and the opening of the second heart catheter X-archive and radiology information offered the most advanced diagno- measuring rooms in the new building. system. This applies to the laboratory sis and therapy in treating cardiac The department of paediatric cardiology institution also, all results values are arrhythmias. The clinic is specially and Munich fire department sharing a done digitally and transmitted through good for the emergency cases of acute civic neonatal emergency service. the internal network to the stations. myocardial infarction, supplied with DHM own research department accom- The clinic has also its special facilities, modern Chest Pain Units. panied with the cooperation of the for example a pharmacy, helicopter With its seven cardiac catheterization Technical University Munich ensure landing place, social service, blood laboratories, the German Heart Center the continuous development of the supply depot and physiotherapy. Munich is one of the largest and most medical methods and an innovative DHM took also into consideration the experienced centers in Germany. science-based medicine. Additional to care of the patient’s relatives, Ronald Catheter-based therapies play also a the experimental animal facilities, McDonald House is on the ground of growing role in the pediatric interven- the DHM has its own research the clinic, taking into consideration tional cardiac catheterization. laboratory for molecular biology and the care of the patient’s relatives, The range of treatment includes the molecular genetics. The valuable new Ronald McDonald House is a home for opening of closed heart valves, dilata- building from October 1996 based on the parents of young patients, a pos- tion of narrowed heart valves and the five operating rooms with complete sibility to stay close to their children implantation of new heart valve, all cardiac surgical facilities, a hybrid during their inpatient treatment.

7 Vision

Humanity approach Responsibility

The German Heart Centre Munich The German Heart Centre combines Above and beyond the specialisation provides state of the art medical care state of art medical treatment with hu- of the various professional groups and for children and adults with cardio- manity. It is the flexible, highly moti- departments, each member of the vascular disorders. vated involvement and cooperation of team is devoted to combining highly- various professional groups working technological medicine with humane as a team that enhances the recupe- care. Because of the substantial re- ration and recovery of the patients. sponsibility assumed by the staff The physical, emotional, social and members, their needs are important cultural needs of the patients as well as well. They must be involved in the as their right to self-determination are decision-making process in their own fundamental to our work. Our goal is and/or related fields. Communication to provide diagnostic, therapeutic and transcends professional hierarchies. other services tailored to the needs of To maintain the high standard of each patient. medicine at the Heart Centre, all staff members regularly take part in profes- sional development programmes.

8 Loyalty Competence Quality assurance

The professional and personal inte- Cardiovascular disease is the most Our treatment depends on the grity of each staff member provides common cause of death in western highest quality standards, the the basis for responsible interaction industrialized nations. In Germany main target of the treatment is the with patients, their relatives and about 6,500 children are born annu- quality improvement of our patient’s colleagues as well as the cooperation ally with congenital heart defects. lives. We lead interdisciplinary with practitioners and other health The German Heart Centre was one conferences and participate in care professionals and institutions. of the first „one-organ“ institutions national and international quality All staff members loyally support to successfully provide interdisci- comparisons, and give further our „enterprise“ German Heart Centre plinary treatment of cardiovascular knowledge and skill to the doctors Munich. We are aiming at optimal diseases. It was our objective to from home and abroad in form of efficiency and a conscientious envi- lower the number of deaths caused training courses. Training and confe- ronmental context. by cardiovascular disorders through rences help us to keep our skills at preventive and highly specialised the highest level, the mild therapy medicine. Clinical research at the methods have been researched and Heart Centre as well as research in used here early. We are interested collaboration with the Technical Uni- in the therapeutic success of our versity of Munich solidify the centre‘s patients, even after their discharge. leading position in the development of diagnostic and therapeutic concepts on a national and international level.

9 How the heart works

No mechanical device, no water faucet, hose day and night shifts that they can be two million new red blood cells. Each or pump is a true match for the human heart; called, in modern business terms, a contains hemoglobin which chemically it is the most efficient pump ever created. joint venture which the heart regulates binds with oxygen. At a rate of seventy and orchestrates. Thirty billion red times a minute, the heart pumps the The size of a clenched fist, the adult blood cells race through the body over blood with its cargo of red blood cells heart pumps up to 8.000 litres of 96,000 kilometres of arteries, veins into the lungs. There the red blood blood daily at a rate of 5 litres per and capillaries, the body‘s express- cells are loaded with oxygen and em- minute. It can theoretically fill three ways, streets and alleys. The capil- bark on a journey longer than twice bathtubs within an hour and fifty-five laries are so narrow that the blood around the world. Olympic-sized swimming pools within cells can only pass through in single the lifespan of a seventy-year-old. The file. As the heart itself needs to be The heart is the first stop. The oxygen heart and blood are essentially inter- supplied with blood, coronary arteries enriched red blood cells are pumped connected, they form a symbiotic re- encircle it like a wreath. from the left atrium to the left ventricle. lationship, a perpetual cycle working Every second the bone marrow produces Pacemaker cells activate the contraction

10 twenty-five litres. The athlete‘s heart also weighs more; the heart of a non- athlete weighs about three hundred grams while that of an athlete can weigh almost twice as much.

In ancient Egypt being athletic could have led to eternal hell and damnation. The ancient Egyptians believed that in course of a lifetime sins accumulated in the heart. The heart was weighed on the final judgement day – the heavier the heart, the more sinful it had be.

However, it was not until the English anatomist William Harvey announced his discovery of the true nature of the circulation of the blood in his „De Mo- tu Cordis et Sanguinis“ (On the Move- ment of the Heart and Blood) published in 1628 that the background for more understanding was established. He calculated that the heart pumped more than twice the entire blood volume of an adult in a half hour. As this volume could never be exhausted and then newly produced by the body, he con- cluded that there must be a finite of the muscular walls of the heart. The the red blood cells flow back to the amount of blood in a closed system of heart valves then open and red blood heart through the veins. They are su- tubes within the body. This was a cells are pumped into the blood vessels. cked into the right atrium of the heart. purely scientific observation; there was Initially, they race through the body; The right ventricle pumps the into the not even a hint of the heart as the cham- near the heart the vessels are like ex- lungs and, once again, the red blood ber of sins or the seat of the soul. pressways. The ultimate goal of the cells are refuelled with oxygen before red blood cells, however, is the each they flow to the left side of the heart. Harvey broke with tradition. 2.100 individual cell. Every single one must Their speed depends on the heartbeat. years before his time, the poets of the be supplied with oxygen and other An athlete‘s heart can beat about two Sumerian Gilgamesh epic viewed the nutrients that can be converted into hundred times a minute, almost three heart as the symbol for emotions. The energy. So their speed is reduced grad- times more quickly than the heart of Chinese attributed to the heart an ad- ually and they are finally dispersed in- an untrained person. An untrained ditional centre of the intellect. Greek to even the narrowest of alleyways. heart pumps a good five litres per philosophers separated formal and After unloading their oxygen cargo, minute; the heart of an athlete pumps logical cognitive ability from the heart

11 and relegated it to the brain. Aristote- in the heart region deceptive. These things intangible, incomprehensible les proclaimed it the seat of the ever- conclusions coupled with those of and otherworldly. Language itself lasting soul. In the Middle Ages the William Harvey changed the reflective balked at the idea of the heart as an heart appeared as a symbol of Christian concept of the heart in the Age of En- organic pump; after all the heart can mysticism. Christian regarded the lightenment. The heart was no longer be broken, one can cry one‘s heart heart of Jesus as a symbol for God‘s the seat of emotions, the soul or of out, lose one‘s heart, or wear one‘s love for mankind. conscience, but rather a perfect hydrau- heart on one‘s sleeve. Even today lic pump. these idioms are common usage. „I think, therefore I am.“ contradicted Scientists have stopped trying to fight the philosopher and scientist René The emphasis on feelings and imagi- psychological explanations since they Descartes in the seventeenth century. nation in arbitrary opposition to logic too are at a loss to explain precisely Doubtful of the faculties with which and reason during the Romantic period what induces this muscular pump to parts of the body were then thought to led to a rejection of image of the heart do what it does. How does a pacemaker be endowed, he considered feelings as a pump. The heart now stood for all cell know it should contract seventy

12 times a minute? What is the essence cularly the vagus nerve, decreases it. ensures rest and relaxation. The of this mysterious force that only a Many people have felt their heart function of the heart, therefore, is few cells possess? In strictly biological beating in both pleasant and unplea- also influenced by emotions, fears, terms, the sinus node in the right sant situations. The parasympathetic joy and mental health. atrium generates electric impulses nervous system, together with the and conducts them throughout the sympathetic nervous system, consti- Theoretically at least, each red blood muscle of the heart, stimulating the tutes the autonomic nervous system, cell can sense if a person is in an heart to contract and pump blood. the branch of the nervous system extraordinary psychological situation. Although this happens independently that performs involuntary functions. The red blood cell has three months of the brain and the spinal cord, it is The sympathetic nervous system to recognise this situation and then influenced by the nervous system. causes sudden heart palpitations by it dies. However, the bone marrow The sympathetic nervous system quickly releasing nonadrenalin at the cease lessly produces new blood cells accelerates the heart rate while the nerve endings of the heart muscle, and the heart continues beating. parasympathetic nervous system, parti- on the other hand, the vagus nerve Incidentally, almost always on the left.

13 Department for Cardiovascular Surgery

The department of cardiovascular surgery at the German The entire spectrum valve are offered at the German Heart Center Munich is known internationally as pioneer of interventions on Heart Center Munich. in treating both acquired heart disease (bypass surgery, both the heart and the heart valve surgery, etc.) and congenital heart disease large blood vessels are Catheter-based aortic valve implan- being the largest center in Germany for pediatric surgery. performed (from complex tation was introduced at the depart- pediatric surgery to val- ment of cardiovascular surgery at ve-sparing procedures, the German Heart Center Munich in coronary artery revas- June 2007. This new treatment opti- cularization, catheter- on has been performed successfully based aortic valve implantation, surgical repair or interventional treatment of on more than 600 cardiac patients the intra-thoracic aorta with stents and artificial heart implantation). in the first four years. In the field of acquired heart diseases, there is a trend towards minimally Patients who were formerly refused invasive methods. The department of cardiovascular surgery has specialized for cardiac surgery because of severe in minimally invasive heart valve surgery. In particular, mitral valve repair is aortic calcifications or severe co- regularly performed through a minimal incision between 5 to 6 cm under the morbidities can be offered the new right breast, which leads to a very good cosmetic result. Aortic valve replace- catheter-based treatment. Catheter- ment can also be performed in a minimally invasive way. The sternum is cut based aortic valve implantation is partially on the upper half of the chest and not completely (partial sternoto- performed on the beating heart, my). The incision is only 6 to 7 cm instead of 20 to 30 cm for full sternotomy. thus avoiding the heart-lung ma- In addition, new surgical methods allow repair instead of replacement of chine. As a truly minimally invasive heart valves. All available repair techniques to preserve the mitral and aortic procedure, no sternotomy is neces-

14 sary. The catheter valve prosthesis diovascular surgery. In addition to Contributions to cardiac surgery: is advanced via catheter through a conventional surgery, interventional @ Introduction of the mammary artery vessel (femoral artery, subclavian placement of stent grafts has been anastomosis in Germany on artery, or aorta) or through the apex performed for several years. The 3 December 1976 of the heart with minimal incisions or new interventional procedures avoid @ The first successful heart transplanta- percutaneous puncture. a thoracotomy and the need of the tion in Germany on 7 May 1981 Procedure time is considerably heart-lung machine. @ Setting up its own homograft bank for shorter as compared to conventional processing human heart valves surgery. All catheter-based proce- Another focus at the German Heart @ Further development of extracorporeal dures are performed in a so-called Center Munich is the treatment of circulation and heart-lung machine hybrid operating room which fulfills congenital heart disease at any age towards automation and miniaturi- all requirements of a conventional from newborn to adult patients. The zation operating theater and is additionally clinic is one of the leading institu- @ Development of a new centrifugal equipped with a modern cardiac tions in this field. The correction of pump for the heart-lung machine catheterization angiography unit. complex congenital heart defects @ Development of minimally invasive is performed even in newborns surgical procedures In the past 30 years, heart valve sur- weighing less than 2,000 grams. @ Surgery with telescopic manipulators gery has always been one main focus Some patients are treated under (robotic surgery) at the German Heart Center Munich. deep hypothermia of the organism @ The first world‘s total endoscopic Based on this long-term experience, using the heart-lung machine. The mitral valve repair with telemanipu- the center for minimally invasive, use of minimally invasive tech- lator „Da Vinci“ in 2000 reconstructive and interventional niques has also been increased in @ Further development of the early treatment of heart valve disease surgery of congenital heart disease correction of congenital heart defects was founded („European Heart Valve during the past decade. For the in infants Center“). Its own working group replacement of the pulmonary valve, @ Pilot clinic in developing quality performs research on valve specific a common procedure in pediatric assurance of cardiac surgery topics. Its medical care services cover cardiac surgery, the German Heart @ Leading role in transcatheter proce- patients with all kinds of heart valve Center has a human heart valve dures: The world‘s first implantation disease who are facing an operation bank (homograft bank), where hu- of a transapical CoreValve on at the German Heart Center Munich man heart valves are processed for 26 June 2007 or return for follow-up. Furthermo- use in the OR. re, the center is also a competent International leading position in partner to answer all queries in this Beyond that the department of complicated congenital heart defects regard for colleagues from other cardiovascular surgery owns a large correction: medical fields. experimental laboratory. Research @ Anatomical correction of TGA projects such as the development of @ Fontan operation Coronary artery bypass surgery is an automatic heart-lung machine, @ Ross operation performed using the most modern tissue engineering, clinical and @ Operation of BWG syndrome surgical techniques. Leading in this experimental study of heart valves, @ Valvuloplasty in Ebstein‘s disease field, graft harvesting is performed the development of new technolo- endoscopically. To avoid a long scar gies for surgical tele-manipulators together with the clinical physicians on the forearm or leg. An incision („robots“), the development of and guarantee an exceptionally high of only 2-3cm results in rather no an artificial heart device, projects scientific efficiency. wound healing problems and a per- on modern imaging techniques, fect cosmetic result. biosignal processing and theore- tical cardiovascular physics are Aortic disease is treated by several conducted there. Engineers and sci- methods at the department of car- entists from other fields are working

15 Prof. Dr. Rüdiger Lange (M.D.) Director of the Department of Cardiovascular Surgery

Interview after the operation. This is a chance to year, about two per day. On the day transform stress into energy. before an operation, I cannot do stre- nuous sports because I need 100% of Even as a student you were deter- Are there times when you regret my energy for the operation the next mined to be a heart surgeon. Why? having chosen this profession? day. I cannot eat too much either be- Surgery on the heart is more complex No. Naturally, sometimes I would like cause then I sleep restlessly. than on motionless organs. But as a to go out to eat or for a walk in the student I did not know that a heart park. Just like that. There are too many How long does a heart operation take? surgeon is exposed to much more days on which I get up in the morning For open-heart operations the heart stress than any other surgeon. and go to the clinic when it is dark out- has to be stopped. This must not take side and when I come home, it is dark longer than three hours. Stress leads to heart attacks, at again. But then there are the moments least some doctors say... of thankfulness that I can help so many Can you interrupt such an operation? Yes, OK. But I think that stress at work people. No. or stress induced by problems is not a cause of heart disease. What is more Those who want to help must suffer? With the need for such high concen- important is how the individual deals The little free time I do have, actually tration, do you sometimes have with stress. My work is very rewarding, has to be coordinated with my work. I doubts about yourself? especially the graditude of the patients perform about 450 operations each No, if a race driver thinks he should

16 drive more slowly, he is not very well are above all afraid when they come to Will genetic engineering and bio- suited for his job. such a highly specialised clinic. The technology change heart surgery? first thing we do is try to alleviate their Both fields will certainly cause major Dr. Brinkman from the Black Forest fear and create an atmosphere of trust. changes in surgery. In the years to come Clinic (a long-running German televi- Not only a relationship of trust with there will be fewer operations because sion series) constantly had self doubts. the nursing staff and the physicians, we will learn how to prevent diseases. Heart surgeons are subjected to much but also trust in the healing power of more pressure than the doctors on tele- modern medicine, which is our most For many people the heart is not a vision. In the programme, the doctors effective tool. normal organ but the site of the soul, are mainly concerned with the personal emotions and feelings. What is the problems and the everyday life of their There are several heart centres in heart for you? patients. If I were to do that, I would be Germany. Is there competition for The emotional component is based on in need of a psychiatrist in a few months. patients? human imagination, not reality. Still, as I get a stomach-ache when I watch those Yes, that is why additional specialisa- a physician I feel respect for the heart. programmes. But I know some collea- tion like here at the German Heart It has a central position in the body. gues who enjoy them. Centre is becoming more and more People feel that it is an organ that has important. The best possible care for a life of its own. But of course that is Do you and your colleagues at least and the wellbeing of our patients de- nonsense. We only live because the have enough time to deal with the termine our thoughts and deeds. That heart supports the circulation. psychological state of the patients? is why many of our patients recom- Of course. Patients with a heart problem mend our clinic to others.

17 Department of Cardiac and Circulatory Diseases

One major responsibility of the German In the developed world, disease of the certified chest pain unit. We know Heart Centre is to open up narrowed coronary heart and blood vessels is currently that the blocked arteries that cause arteries without a need for open-heart surgery the leading cause of death. In fact heart attacks must be opened as soon it outnumbers deaths from cancers as possible. It is well-recognized that and accidents combined. Diseases more “time saved” means more “heart of the heart and circulation may be classified into 3 main areas: heart disease muscle saved”. Furthermore it is now including heart attack and serious rhythm disturbances, stroke and disease of clear that opening the clotted-off the arteries to the brain, and disease of the arteries supplying the arms and artery that is causing the heart attack legs. The German Heart Centre is at the forefront in fighting disease in all 3 of saves more lives than using “clot- these areas. busting” drugs. For this reason every From diagnosis of disease in high-tech cardiac computed tomography and state- minute counts and the German Heart of-the art magnetic resonance scanners to immediate specialist treatment, the Centre offers patients around the clock German Heart Centre offers patients the full spectrum of cardiovascular care. emergency heart catheter service 365 Procedures to re-open blocked arteries are performed by dedicated teams days a year. In addition, the research working full-time in the centres cardiac catheterization laboratories. Coronary work of our specialists has helped events are frequently caused by occlusions of epicardial artery vessels. Dila- guide the treatment of countless heart tation with a small balloon enables to re-establish blood flow, which is mostly attack patients world-wide. supported by the implantation of a stent. The German Heart Centre has been a The DHM offers also treatment for world leader in stent development and testing over the last 15-20 years. occlusion or severe narrowing of Patients who are having a heart attack need prompt care. All patients with the arteries of the neck or the legs. chest pain or complaints are initially assessed for signs of heart attack in our Further, narrowed and calcified heart

18 valves can be safely treated in a Contributions in Cardiology specific operation room. With these possibilities a complex valve repair Coronary heart disease can successfully be performed without @ improved interventional therapy of acute myocardial infarction open heart surgery. @ optimized medical management in acute coronary syndrome Serious rhythm disturbances lead @ strategies for coronary revascularization in complex cases of coronary heart disease to sudden heart failure and death in Heart rhythm disorders over 100,000 Germans every year. @ catheter-based ablation in atrial fibrillation, ventricular tachycardia and focal rhythm One of the key responsibilities of our disorders centre is to detect and diagnose these @ complex pacemaker systems, implantable defibrillators problems. Electro-physiological exami- @ left atrial appendage occlusion to prevent stroke nations using controllable catheters Cardiac valve disorders allow for precise insight into the @ interventional aortic valve replacement electrical circuitry that controls heart @ interventional therapy of mitral stenosis and insufficiency function with every heartbeat. Life- Heart failure threatening rhythm problems can be @ comprehensive pharmacotherapy overcome through the implantation of @ device therapy (resynchronization) pacemakers and defibrillators as well @ ventricular assist devices (in cooperation with cardiac surgery) as through the ablation of abnormal @ physical training (in cooperation with sports medicine) heart conduction pathways. Patients Structural heart diseases with life-threatening disease are mo- @ quantification and catheter-based therapy of hypertrophic cardiomyopathy nitored continuously in our intensive @ myocardial biopsy care units using the newest tech- Inherited heart diseases nology and highly trained staff offer @ family-based counseling for inherited heart rhythm disorders, heart muscle diseases mechanical support of failing cardiac and positive family history of coronary artery disease and respiratory function and dialysis @ molecular cardiology: identification of genetic causes of myocardial infarction replacement of kidney function. On Atherosclerosis/high blood pressure the other hand stable patients can @ improvement of interventional therapy for arteriosclerotic vascular disease recover on our modern cardiac wards @ denervation of renal arteries to treat resistent high blood pressure and in our VIP patient suites. Disease of the arteries to the brain is the leading cause of stroke. Our team of specialist angiologists diagnoses and treats this problem on a daily basis. Where previously open surgery was necessary to relieve blockages, multiple medications that is otherwise the procedure is now performed under required by patients to keep their local anaesthesia using balloons and condition in check. stents. Similarly obstructions to blood In the field of scientific research the flow in peripheral blood vessels, German Heart Centre is a pioneer and which can lead to gangrene and the work of its investigators has hel- amputation, are relieved with modern ped to shape the treatment of patients drug-coated balloons and stents. An around the globe. Local investigators area of particularly active develop- and scientists from many countries ment is the treatment of high blood work together on projects from basic pressure with a catheter ablation of experimental bench work to trans- the nerves to the kidneys. This offers lational medicine and trials of new the chance to relieve the burden of medicines and technologies.

19 Prof. Dr. Heribert Schunkert Director of the Department of Heart and Circulatory Diseases

Interview What is your approach? procedures in order to reopen occlu- Importantly, one senior physician has ded coronary vessels, to treat heart to overlook all information available rhythm disorders and heart failure, Prof. Schunkert, you are the new for a patient. In fact, often it is not only or to replace cardiac valves. In fact, director of the Cardiology Depart- the heart but its interaction with other most cardiac disorders can be treated ment. Where will you place the focus tissues, for example the kidney, which nowadays with various catheter-based of your future work? causes a given health condition. interventions. The heart is a wonderful organ. How- Our team at the German Heart Center ever, it may cause difficulties in one Munich aims to understand the overall All these procedures require longtime or the other way. The most frequent situation of the patient in order to experience and can be realized only by cardiac problem results from poor provide optimal treatment. a highly specialized team. blood supply to the heart. Moreover, heart failure, heart rhythm disorders, How do you qualify the physicians We at the German Heart Center are heart valve disorders or diseases of of the German Heart Center Munich? fortunate to conduct a large number of the large vessels may occur. Modern cardiology developed highly procedures (more than 8000 per year), sophisticated instruments for the such that we have highly trained and Our team at the German Heart Center treatment of various cardiac condi- experienced investigators for each of Munich offers care for all these cardiac tions. In this respect, we practice a these conditions. conditions. large number of minimal invasive

20 Likewise there has been enormous progress in the treatment of atrial fibrillation or ventricular tachycardia by catheter ablation, which became routine in our hospital. Thereby, many patients can avoid long-term medical treatment. The earlier ablati- on therapy is conducted the better is the outlook. Heart failure is nowadays treated by complex but highly effective medical treatment. In patients with more severe heart failure, we offer novel treatment modalities including defi- brillators, resynchronization therapy and cardiac assist devices. Finally, well-balanced physical exercise in patients with heart failure becomes a strong focus of our work. Catheter based treatment of coronary and peripheral arteries became better and better. Coronary stents of the second and third generation are well tolerated and cause only rarely What is the personal focus of your Fortunately, in our Heart Center we live re-occlusions or thrombus formation, work? a special team spirit in working toge- which markedly improved long-term Together with the patient I wish to ther with cardiac surgeons, pediatric success. develop a treatment strategy that cardiologists and specialists in cardiac serves the needs in the individual anesthesiology and cardiac imaging. What is the reputation of the German situation. Both patient preferences I am very thankful to find all these Heart Center Munich in the academic as well as the needs of the respective disciplines in our house such that we world? cardiac condition and the subsequent can offer the full treatment spectrum A number of cardiac societies from all treatment options need to find consi- to each and every patient with cardiac over the world send their most talented deration. Many hours a day I spend in conditions. physicians to train at the German the catheterization laboratory to take Heart Center, which we consider as a care of my patients. You mentioned before that your great honor. Indeed, many of our staff discipline, cardiology, underwent physicians are professors for young What are the challenges of the enormous progress. What are the colleagues coming from all over the future? greatest achievements? world. A major challenge is to treat patients Treatment of elderly patients with less invasively. Such sophisticated severe calcification of the aortic Of course, we are very glad to see that treatment requires an optimally struc- valve or leaky mitral valves has been Focus, a leading journal of the lay tured team of physicians, nurses and very difficult. Nowadays, we can take press, elected the German Heart Center physical therapists. To guide this team care of these patients with minimal- Munich and its cardiologists and hyper- towards ever increasing challenges is ly invasive procedures in order to tension specialists into the top ranks of certainly a highly demanding task. replace or fix a broken valve. respective fields in Germany.

21 Department of Paediatric Cardiology and Congenital Heart Disease

When the German Heart Centre Munich was in case of stenotic valves (aortic valve, than one year - undergo surgery every founded in 1974, the idea of diagnosing and pulmonary valve), interventional pul- year. All preoperative diagnostic mea- treating any illness of the heart at any age was monary valve implantation, balloon di- sures are available in the Department unique in the world and was copied by many latation and / or stent implantation in of Paediatric cardiology and Congenital hospitals in several countries afterwards. vascular stenosis (pulmonary arteries, Heart disease including ultra fast coarctation of the aorta), closure of computer tomography and magnetic The Department of Paediatric Cardiology atrium- and ventricular septal defects resonance imaging. and Congenital Heart Disease cares for as well as closure of open ductus patients with congenital heart defects arteriosus. After surgery the patients will be from fetus to the adult and is one of the transferred directly to the intensive most active centres in Europe. Head of The closure of atrial septal defects are care unit 3.3 of the clinic. With its fully the Department is Prof. Dr. Peter Ewert. performed under echocardiographic equipped 16 beds, this ward is unique guidance without any X-ray exposure. in Germany. State of the art diagnosis and treatment Transesophageal echocardiography in are offered to 9.000 patients (7.000 complex lesions pre- and intraopera- outpatients and 2.000 inpatients) every tively is one of the topics in the echo year. More than 600 cardiac catheteri- lab. Over 10,000 transthoracic and zations in two digital biplane catheteri- 800 transesophageal examinations zation laboratories are done every year, were done in 2013. the vast majority of which are therapeu- tic interventions like balloon dilatation 550 patients - more than 200 younger

22 Specific achievements of the department

@ Interventional cardiac catherization (repair) All interventional cardiac catherization treat- ments are available. Interventional pulmonary valve implantation, opening closed pulmonary valves (Radio frequency perforation), Balloon dilation of aorta and pulmonary valves, angio- plasty and „stenting“ of pulmonary artery stenosis and descending aorta, catheter As children are not just little adults and department, the executive secretariat, device closure of the atrial septal (ASD) and adults with congenital heart diseases spiroergometry and the magnetic ventricular septal defects (VSD), closure of are not children, a warm and familiar resonance imaging (MRT) are situated aortopulmonary collateral vessels, coronary nursing atmosphere is provided on on the ground floor. artery fistula and patent ductus arteriosus the two standard wards. 23 beds are (PDA), ductus stenting. reserved for neonates, infants and Admission for diagnostics or therapy @ Echocardiography school children (ward 3.1) - 6 rooms are (cardiac catheterisation or surgery) is Fetal echocardiography (with 3-D recon- specially equipped for mother and baby possible at any time, at night and at struction), transthoracic and transeso- nursing. day, on seven days a week. The medical phageal echocardiography (TTE) team consists of 39 physicians (25 spe- @ Electrophysiology On ward 3.2 (for adolescents and cialists and 14 doctors in training). Mapping of all primary and secondary atrial adults), there are 15 beds divided in arrhythmia with the CARTO system, ablation five single rooms (hotel standard), two As part of the Technical University of Department of Paediatric Cardiology and Congenital Heart Disease of atrial and ventricular tachycardia in hearts double rooms and two triple rooms. Munich there are widespread research with complex cardiac defects, for instance Central monitoring (ECG, oxygen satu- activities: basic research in the field after Fontan operations or after transposition ration, blood pressure, respiration) is of pulmonary hypertension and its of the great arteries (TGA) possible at every spot. molecular regulation, acute inflamma- @ Paediatric Cardiac Surgery tory disease in children after bypass Every type of reconstructive and palliative Psychosocial support during the every- operation, departmental research with cardiac surgery, including the Norwood day business at the clinic is provided by special interest in myocardial perfusion palliation, staged univentricular heart palli- two specialised nurses, one psycho- and cellular metabolism in congenital ation, correction of anomalous left coronary logist and an occupational therapist heart disease, haemodynamic and artery from the pulmonary artery (ALCPA), who care not only for the patients but morphologic correlation in univentricu- Fallot‘ tetralogy in neonates or infants less also for the parents in their difficult lar hearts, and specific cardiovascular than one year of age, AV septial defects, situation before or after the operation. monitoring on the ICU. reconstructive surgery of Ebstein‘s abnoma- In case of a longer hospital stay, school ly as well as the Ross operation (also neonatal) children are supported by an in-house school. In the hospital area there is an Specific tasks of the German Heart Centre as a apartment house with 27 apartments university clinic: for parents and other family members @ educational courses for medical students available. @ basic research in the molecuar biological laboratory The Department of Paediatric Cardi- @ clinical long term follow up studies after ology and Congenital Heart Disease specific treatment of congenital heart is located on the third floor with all disease, studies on myocardial performance three wards (54 beds in total), two cath and myocardial perfusion labs and two echolabs. The outpatient

23 Prof. Dr. Peter Ewert Director of the Department of Paediatric Cardiology and Congenital Heart Disease

Interview ren. A needle hurts, surely nothing to real clowns, that come once a week argue about, but when you are able to to cheer up the children. A wonder- encourage a child that they can bear it ful thing! But the clowns visit the Is it different to treat children? – it may even have the chance to grow. ward for adults with congenital heart Oh, yes. To treat children is a special diseases, too. One can never be too challenge, but at the same time an May there be psychological damage old for clowns in a hospital. extraordinary luck, because today if a child spends a long time in we are able to help most of our little hospital? Do parents also provide support for patients in a way that gives them the It may happen but it is not inevitable. We their children? possibility to lead a relatively un- need more psychologists and specialised Of course! They are the most burdened life. But we are no longer teachers to care for these children. But, important backup for their child- purely a pediatric clinic. Half of our even though it seems not to “pay off” in ren – especially at the hospital. patients are adults with congenital relation to economical benchmarks, and During a heart catheter examination heart diseases. They are special as I take pride that our hospital employs a for example, I offer the relatives if well, since many of them are well psychiatrist, a children‘s play therapist they want to, to stay in the catheter known to us since their birth. and two specially trained paediatric laboratory. Whatever we are doing nurses for the support of our team for is not witch craft and the relative’s How do you win the trust of children? psychosocial care. presence enhances better under- At first the parents have to be convin- standing and confidence. We might ced of what we are doing and to trust Sometimes clowns hop around the not forget, however, that a clinical us. And then it is most important to wards… stay can push the parents to their be open and sincere with the child- Yes, those are our hospital clowns, limits, too. Therefore it is important

24 to offer them support. Of course! This is not that rare. There This is an important part of the progress was a lot of reluctance in the past, but in the treatment of the young patients You have three children yourself. nowadays we know that in most cases with congenital heart diseases. What goes through the mind of pa- this is not a big problem. We know our rents on learning that their child female heart patients very well and are The death rate in the Department for has a heart defect? able to advice and comfort them during Paediatric Cardiology is less than They experience a shock. Always. their pregnancy. The connection to a three percent… You have to give them time to realize. center with adequate experience is …this is unique in Germany. There are But there are also soon-to-be most important. very, very rare departments in the parents who already know, based world with such a low rate. Of course on the prenatal ultrasound, that What goes through your mind when this is wonderful, but for us it is now their child has a heart disease. you cannot help a child? important that the children and the Thus, we offer a prenatal outpatient If a patient is passing away in my clinic young adults, who are leaving our cli- consultation for them. Fortunately, it is very, very tragic, no matter if it is a nic, feel as healthy as possible. Most we can offer treatment for nearly child or an adult, because they are of them are having a high life span all congenital heart defects and the young patients! The whole team tries to and- at least just as important, they children not only survive, but have a comfort the relatives during this situa- have a high quality of life, in spite of high quality of life. tion. In the aftermath we come together the congenital heart disease. as a team. We discuss whether we can Are there young adults who were learn something of the incident, to do operated at your clinic and now want something different next time or to have children of their own? probably find a complete new approach.

25 Prof. Dr. Peter Tassani-Prell Director of the Institute

Institute for Anaesthesiology

Highly specialized cardio-anesthetists ren- The physicians of the Institute for After a detailed preliminary discus- der the whole spectrum of cardiac surgery Anaesthesiology treat and monitor all sion with the patient in the ward, one as it is routinely practiced at the German patients who underwent heart ope- day before the operation, all patients Heart Centre Munich. rations in the operating room and in are given a tranquilizer for the night the intensive-care unit. Our anaesthe- and a strong „pre-anaesthetic medi- siological team manage increasingly in applying the anaesthesia process on cation“ on the day of surgery ahead elderly patients with a long process of illness or in a strongly impaired general of removal to the operation room as departmental condition through the preoperative phase. Since 30 years, staffs prescribed by the anaesthetist so that of the department have been meeting the complex standards in cooperation they are already very sleepy when the with the affiliated blood-group-serological laboratory and blood bank, its unit actual anaesthesia is introduced in for pre-surgical autologous blood donation as well as physiotherapists belonging the vestibule of the operation room. to the institute. During surgery, the patients are Given the system of autologous blood donation which was introduced in 1989, surveyed at the highest safety level the probability of using blood transfusion stemming from third parties in ope- with the most modern hemodynamic rations could be drastically reduced. interlinked monitoring system, and The donated blood components before the operation, are often separately pre- computer-controlled data manage- served and made ready for the operation. ment.

26 Milestone contributions to anaesthesia @ Introduction and further development of intravenous anaesthesia methods with ultra short acting anaesthesia and analgesic agents in the sense of a total intravenous anaesthesia. @ Application of electro-acupuncture as a supplement to the general anes thesia in more than 1,000 operations. @ Directive departmental examina tions for recording the impacts of extracorporeal circulation on the clotting system @ Examinations for the pharmacologi- cal treatment of the malfunction of blood clotting during and after extra The latest equipment in form of modified EEGs are available for each operation to corporeal circulation to avoid homo measure the anaesthesia and adjust the optimal dose for each patient. logous blood products @ Introduction of mechanical blood- The maintenance of sufficient circulatory conditions during cardiac surgery parti- saving measures after heart opera cularly after the deactivation of the heart-lung-machine, is mostly possible only tions by the use of sophisticated medication to increase the contraction force of the @ Build-up of autologous blood donation heart, or to regulate the diameter of the blood vessels. system @ Working out the theoretical and tech The transesophageal echocardiography is used in all cardiac operations, espe- nical prerequisites for the perfor- cially for valve surgery and congenital heart defects, this means controlling the mance of hypothermal circulatory result directly at the end of the operation. arrest for the correction of cardiac diseases One focal point of the department lies in the pre-surgical care and medical sup- @ Introduction of new techniques for ply for children and babies. Far more than 13,000 children and new-born babies the pharmacological and mechanical have been treated from 1974 to 2010. impacting of systemic inflammatory response during and after extra- Our common goal is the primary surgical correction of complex congenital heart corporeal circulation disease in infancy. The decisive progress in the field of heart surgery together @ Introduction of the pre-operative, con- with the extracorporeal circulation and the anesthetic management enabled tinuous computer-backed recording DHM nowadays to carryout almost all kinds of heart operations even in newborn of the vital parameters of patients for and premature babies with body weight less than 2,000 grams, through the use documentation and quality assurance of the heart-lung machine.

27 Dr. Siegmund Braun Director of the Institute

Institute for Laboratory Medicine

„Good is not fast enough“ is the motto The laboratory medicine is essential in the process of diagnosis, disease pro- of the Institute for Laboratory Medicine. gnostic assessment, therapy control as well as the detection of cardiovascular With 40 percent intensive care beds, the risk factors. laboratory must offer high-quality analy- tical diagnosis in minimum processing The Institute generally works behind the scenes and is often not apparent to times. the patient. Laboratory physicians advise doctors, nursing staff and patients in all matters of this rapidly advancing interdisciplinary field.

Several hundred analytical procedures for characterising naturally occurring substances, cells as well as drugs are constantly being updated and maintained at the state-of-the-art. Presently about one million individual assays in the area of hematology, hemostasis, general clinical chemistry, immuno- logy and protein chemistry, serology, endocrinology, metabolism, gene testing and drug monitoring are carried out each year exclusively by specialists. All laboratory results pass through a multi-step technical and medical review process before the findings are made available to the physicians at the ward. The measurements obtained are put through rigorous verification and continuous internal and external quality control measures to ensure their accuracy. The findings are then validated through a patient-oriented medical assessment carried out by the doctors at the Institute.

28 Contributions to Laboratory Medicine

@ Development of laboratory techni- ques and methods for the prophyla- xis, diagnosis, therapeutic monitoring and monitoring of the course of heart diseases. @ Competence centre for laboratory medicine @ High-efficiency analysis @ Frequent and detailed advisory service @ Patient training @ Optimisation of economic efficiency by means of business administrative methods and of application of Total Quality Management (TQM)

The modern facilities are supported by an efficient laboratory IT system that is Scientific contributions fully integrated throughout the entire hospital information system. @ Evaluation of new biochemical markers The Institute follows since more than 15 years the fundamentals of business for diagnosis, therapeutic methods excellence, it was considered in 1999 through an external assessment as the and prognosis of cardiac diseases. first in its art according to the model of the European Foundation for Quality @ Studies conducted to investigate the Management (EFQM). The Institute received in 2006 as the first in Europe the changes in blood coagulation and recognition „Recognized for Excellence“ EFQM. inflammation reaction during and after heart surgery Pathobiochemistry and the improvement of diagnostic techniques for heart @ Introduction of platelet function testing disease remain at the forefront of research at the Institute. However, it also fo- in the routine diagnostics. sters the research of all other departments of the hospital as well as external @ Study on the value of cardiac and in- partners of the Technical University Munich with its analytical skills. flammatory markers in the field of sports medicine. The Institute is a leading centre for educating patients on self-management of oral anticoagulants. (Contact person: Dr. S. L. Braun)

29 Dr. Stefan Martinoff Director of the Institute

Institute for Radiology und Nuclear Medicine

DHM diagnostic radiology offers all the fastest and most advanced CT system works 24 hours a day similar to the necessary techniques for different exa- (currently dual-source CT Flash). The radiological diagnosis department. minations, covering digital pulmonary most outstanding investigation here function test and all types of vessel ima- is the non-invasive coronary angio- In addition to specific nuclear cardiolo- ging in non-invasive technique. Children graphy, therefore it is known for the gy techniques, the department offers are examined with the lowest doses (e.g. manufacturer and for dose-saving also a complete spectrum institute of pulsed screening, digital X-ray technology heart examinations as international nuclear medicine, the examinations and MRT). reference address. are carried out with a modern digital dual-head camera, the diagnostic A 1.5 Tesla magnetic resonance ima- main points are the scintigraphic ging is is also available since 2006, diagnosis of acute myocardial infarc- which is mainly used for the detec- tion and the congenital heart defects tion of heart disease in childhood examinations. and adulthood. As German Heart Centre Munich The Institute has a radiological infor- Regarding the research sector, the in- early 2002 was the first worldwide mation system (RIS) and a so-called stitute works together since May 1998 in using the 16 lines Multislice CT, PACS (Picture Archiving and Commu- with the director of the nuclear medi- managed an innovations contract nication System) for patients images cine hospital of the Technical Universi- that allows regular upgrades to this and medical results archiving, and ty Munich (Prof. Dr. M. Schwaiger).

30 Contributions to Radiological and Nuclear-Medical Scientific contributions Diagnostics

@ Co-introduction of the digital subtraction angiography in @ Participation in the scientific evaluation of interventional venous and arterial vascular diagnostics and operative therapy concepts in myocardial revascula @ Introduction and optimization of myocardial scintigraphy rization particularly with nuclear-medical methods. in planar – as well as in SPECT-technology @ Participation in the scientific evaluation and further develop- @ Optimization of non-invasive nuclear-medical diagnostics ment of the interventional treatment of carotid stenoses of complex paediatric cardiac dysfunctions by means of stent implantation in cooperation with the @ Co-introduction and optimization of the digital x-ray departments of angiology and neurology of the Technical technique as well as introduction of picture archiving and University of Munich. distribution techniques @ Carrying out studies in the field of cardiac imaging (in @ Introduction of non-invasive coronary angiography by close cooperation with the adult cardiology department) means of the 16-line multi-slice CT into the diagnostic routine @ Pioneering in publications and management of multi- @ Introduction of sub-mSv coronary CT using Flash-Scan center studies on radiation dose in cardiac CT

31 Burkhard Köppen Director of Nursing Care

Patient Care

A qualified and motivated nursing staff At German Heart Center Munich there are 400 health and nursing personnel is necessary for the successful treatment as well as employees from the voluntary social year (FSJ), trainees from Munich and care of patients. These professionals vocational nursing schools BRK and „Maria Regina“ plus the technical surgi- are primarily motivated by a deep Chris- cal assistants-school (OTA) of Rosenheim hospital. All doing their best for the tian need to care and look after patients. physical and psychological well-being of the patients. The adults and children professional nurses who represent the largest occupational group at German Heart Center Munich, are in constant commu- nication with the doctors and the other responsible staff, the medical care is based on a possible partnership between the carer and the patients. The high quality of patient care at the German Heart Centre can also be attributed to the excellent working conditions offered by this modern and state-of-the-art clinic. Tasks not within the sphere of patient care such as providing the Heart Centre with drugs and medical supplies or waste dis-

32 The members of the nursing staff of the German Heart Centre are respon- posal are relegated to ancillary personnel. Consequently, the 400 members sible for: of the nursing staff can attend exclusively to their specific duties. Patient care at the Heart Centre is marked by individual planning according @ Three cardiac medical and surgical to standard guidelines. Qualified and experienced professionals are on duty adult wards around the clock in three shifts. @ Two intermediate care wards for adults Each ward has a head nurse whom the patients can contact if they have @ Three intensive care units for adults special requests and questions. @ Emergency admission unit for Continuity between the shifts is assured by direct interaction and a briefing adults - Chest Pain Unit (CPU) on the particular care of each individual patient. @ Two cardiac wards for children @ Intensive care unit for children The goal of the nursing staff is to provide committed and medically sup- (divided by age) ported patient care for the wellbeing of each individual. @ Central operating rooms with central sterilisation facilities @ Anaesthesiology department @ Eight cardiac catheter units for inter- vention therapy for adults and children

33 Hybrid operating theatre

German Heart Center Munich has a Hybrid operating the- open surgery or endo- severance or the use of the heart-lung ater since early 2007. This new room which represents a vascular - a catheter machine. The procedure is performed combination of a fully equipped cardiac surgical operating through a vessel - or on the beating heart with minimal room and a fully satisfying cardiac catheterization lab led a combination of incision or interventional (inserting a to completely new therapeutic options in the heart surgery. both processes. The catheter through a vessel). Hybrid allows also an In case of a sudden need for an open immediate surgical heart surgery instead of a planned Cardiac surgeons, cardiologists and result monitoring by ultrasound, much interventional procedure, the Hybrid anaestesiologists work closely together. better as the traditional monitoring, a operation theater provides the highest In addition to all facilities of a cardiac significant gain for the patient concer- level of safety by doing the operation operation theater, a hybrid operation ning treatment safety and quality. directly, saving both time and risk room offers additionally X-ray possi- The possibility of endovascular casued by transporting the patient in bilities and hemodynamic measure- process has gained also a great a serious situation. The cooperation ments, as known from a cardiac cathe- importance for the bypass surgery of experts from different fields in the ter laboratory. Through rotation of the and heart valve replacement, severe Hybrid operation room will overcome X-ray arm, a CT-like and three-dimensi- peripheral vessels narrowing can be not only the limits in the treatment onal imaging is made possible. Cardi- treated at the same time during the methods but also the historical ological and cardiac surgical emer- main surgery, this reduced the risk of limitation of the different medical gencies can be diagnosed and treated serious blood circulation disorder. fields. The modern technology of a in the new hybrid operation room New therapeutic options methods in Hybrid operating room provides new simultaneously without any delay or the cardiology and heart valve surgery, therapeutic options for the patients additional transport risk, exemplary such as catheter-based aortic valve who were previously not operable and are the acute aortic diseases, such as replacement, can only safely done in facilitate the high risky operations. aortic aneurysm or aortic dissection, a Hybrid operating room, avoiding these can now be treated trough an both, a major operation with sternum

34 Somatom Definition Flash (Dual-Source Heart - CT)

As German Heart Centre Munich early 2002 the first worldwide who used the the the few global reference addresses 16 lines Multislice CT, managed an innovations contract that allows regular for the cardiovascular dual-source ma- upgrades to the most efficient multi-slice CT system (Somatom Definition Flash nufacturer and known as location for since April 2009). the DSCT, therefore, the exclusive heart CT for the Federal German Air Force is In addition to its complete high-resolu- The diagnosis requires relatively a in this clinic. tion computed tomography - non inva- short time (for the thorax less than 1 sive vascular imaging of the whole second) and is very comfortable for This devise is operated in a close body - manage also a sharp and clear the patient, provids fantastic three- cooperation between the department representation imaging of the non-inva- dimensional images of the heart and of adult cardiology (Prof. Dr. Schunkert) sive coronary arteries with a dose of less its coronary anatomy. and the institute for radiology and than 1 mSv. German Heart Center Munich is one of nuclear medicine (Dr. Martinoff).

MAGNETOM Avanto

The new 1.5 Tesla Magnetic Resonance imaging (MRT) type Avanto with its whole-body technology is available in German Heart Center Munich since early 2006, all standard MRT scans, including all cardiac imaging in child- ren and adults are carried out here without radiation exposure, in this aspect there is a close cooperation between the department of congenital heart defects and the department of adult cardiology.

35 Robert Siegert Commercial Director

Public corporation with modern management

German Heart Centre is a public corpo- The management works according to the public regulations ration in a framework of a non eligible determined by the state budget and the Bavarian financial institution under public law. regulation.

This combination of commercial business and modern mana- gement methods, within the above mentioned framework, in adittion to its own independency and together with the excel- lent medical services, contributes significantly to the success of the clinic.

Nowadays, the use of modern management methods has been increased due to the competition growth among the hospitals.

The essential adjustment of the framework scope takes the first place in this develop- ment process, which insured continuously the economic security of German Heart Center Munich.

36 37 1 Leadership 2 Policy and strategy 4 Partnerships 3 and resources People 5 Processes 7 People 6 results Customer 8 results Society results 9 Key performance results

Total Quality Management (TQM) – a puzzle with nine pieces

At the time of its founding in 1974, The German Heart Centre has a traditi- The German Heart Centre and four the German Heart Centre Munich was on of excellence. Since 1974 outstanding other clinics were at the forefront in the first heart centre in Germany; medical quality has been the overriding the development of quality manage- since then many more heart centres goal of the hospital management. As ment for cardiovascular surgery. In have followed its benchmark example. internationally recognised specialists, 1986 the German Society of Cardiovas- they motivate their co-workers to attend cular Surgery set up a commission to critically ill patients at a first-rate, to develop quality control; the German state-of-the-art institution. Heart Centre was a member from the Each and every one is committed to the reduction of the death rate of cardiovascu- very beginning. The pilot study QUADRA lar disorders. Quality control has been an integral part of the medical and nursing was sponsored by the German Mini- profession for the last forty years. stry for Research and Technology as well as the Federal Ministry of Health Nevertheless, medical and technological advances, the complex organisation of and Social Security. Today all clinics a hospital at which a successful medical outcome is the result of many intercon- for cardiovascular surgery in Germany nected steps, and increasing economic pressure in the field of health care call for participate. In the midnineties, the even more effort: the key concept is quality management. German Heart Centre was among the As opposed to many other countries, quality control and certified medical quality first to take part in the project for were not required by law in Germany for a long time. Often taking the initiative, quality control in paediatric cardiology. the German Heart Centre‘s proactive introduction of systematic quality control and extensive quality management was pioneering. The German Heart Centre has operated

38 Quality management, Total Quality Management (TQM) and the European Foundation for Quality Management Excellence Model (EFQM-Model) are concrete tools that continually challenge us to excellence. It is a puzzle with nine pieces.

1 Leadership. We self critically assess our management style. A patriarchal system no longer meet the requirements of a modern heart centre.

2 Policy and strategy. We realize that there are heart centres other than ours. We do not fear transparency or competition and are at all times willing to have the quality of our work independently assessed.

3 People. Keeping abreast with state-of-the-art developments and advance ments is imperative at a high-tech medical institution. Professional develop- ment and close collaboration with other departments is therefore crucial.

4 Partnerships and resources. National and international cooperation in research, health care as well as management is maintained and encouraged. We share information and learn from others. according to the Total Quality Manage- 5 Processes. Diagnosis and treatment is more than the sum of its individual ment (TQM) guidelines since 1997 and steps. The improvement of this process is a constant obligation. was the first hospital of its type to be internally assessed according to the 6 Customer results. Over and beyond successful medical results, we take into model of the European Foundation for account of the personal opinion of our patients and the referring physicians Quality Management (EFQM). This model, as well as self help groups and organisations. originally used in the industrial sector, has become widely accepted in the 7 People results. The satisfaction of our patients is dependent on the satis- field of health care. faction of our employees. Although not only because of this, we try to provide optimal working conditions. In 1999 the German Heart Centre com- peted for the Ludwig-Erhard Prize, the 8 Society results. Our mission, the state-of-the-art medical treatment and care German award for outstanding quality, of patients with cardiovascular disorders, is one we always have accomplished which requires extensive involvement successfully. We are interested that the general public also be made aware with the principles of quality manage- of this. ment. The German Heart Centre was ho- 9 Key performance results. For more than 40 years excellent medical and noured as an exemplary organisation scientific results are a matter of course for us. We will and must continue and paragon for all health care facilities. to provide such results in accordance to our guidelines for thrift and eco- nomising requirements.

39 Ronald McDonald House Munich at the German Heart Centre

McDonald‘s Kinderhilfe Stiftung is the provider of in a pleasant atmo- friends and donors from the industry Ronald McDonald House at German Heart Center sphere. The costs and trade fields, besides individu- Munich. It has the aim helping seriously ill children for this families als who support Ronald McDonald and their families. apartment is 20 Houses. All these sponsors help Euros per night, many children in getting healthy The main point in this project is to usually paid back from the insurance quickly through the love and support offer Ronald McDonald Houses in companies. Each year, obtain around of the nearby parents: Closeness the neighborhood of special clinics. 600 families this kind of help and helps recovery. They offer the parents and siblings support. of seriously ill children during their McDonald‘s Kinderhilfe Stiftung has hospital stay a temporary home to re- been engaged since 1987 for the main close to their young fosterlings. health and welfare of the children Ronald McDonald House Munich In this parents‘ house, find the family in Germany. The foundation runs at the German Heart Centre a retreat possibility from the exhau- nationwide 19 Ronald McDonald sting clinic everyday life but also a Houses, close to children‘s hospitals Manager: Tanja Forderer-Barlag quick return to their child to give him as a temporary home for the families Lazarettstrasse 40, 80636 Munich what the medicine cannot give: love, of seriously ill children and be able Fon: +49 (0) 89 189507 - 0 strength and confidence. through 3 Ronald McDonald Family Fax: +49 (0) 89 189507 - 131 Ronald McDonald House is at German Rooms to return back directly and Mail: [email protected] Heart Center Munich since 1995, it safely to their child at any time. The was completely remodeled in 2012 foundation supports also projects Donations account and provides now 24 comfortable which devote themselves to the child- Stadtsparkasse München apartments and shared rooms like ren wellbeing, and it is also a part of Account no.: 1002553046 kitchen, three living rooms, one an international organization working BLZ: 701 50000 playing room for younger children according to the same principles. IBAN: DE88 7015 0000 1002 5530 46 and laundry facilities. The main and McDonald´s Germany Inc. covers, BIC: SSKMDEMM volunteer staff help and advice the as the largest donor, the annual families; therefore there is a weekly administrative costs of McDonald‘s Further information can be found on: gourmet breakfast and family dinner Kinderhilfe Stiftung, there are also www.mcdonalds-kinderhilfe.org

40 [ ] I would like to become a member of the Friends of the German Heart Centre Foundation.

[ ] I will submit my yearly membership fee of the amount of Euro € ______(minimum yearly amount 60.- €) by bank transfer: Stadtsparkasse München, BLZ 701 500 00, Kto-Nr. 33 33 36

[ ] You may book my yearly membership fee directly from my bank account of the amount of Euro ______(minimum yearly amount 60.- €) Bank ______Bank code ______Account number ______Förderverein Deutsches Herzzentrum e. V. attn. Mr. Köppen Date ______Signature ______Treasurer Lazarettstr. 36 [ ] I do not wish to become a member but would like to support your work with a donation. 80636 München Please send me a bank transfer form. Germany Name ______Street ______Zip ______City ______

Date ______Signature ______

Friends of the German Heart Centre Foundation

The Friends of the German Heart Centre Foundation was budget, the annu- If you would like to support our cause founded in 1986 to aid the Heart Centre in achieving its al report and the with the enrolment as a member or goals by providing financial support from donations and recruitment of new with a donation, you will not only be membership fees. members. Along making a contribution for the advan- with the commitee cement of medicine but you will also In the prevailing times of limited they also promote the goals of the help us in an endeavour which - as financial resources and in spite of fees Foundation. everyone knows - may be of benefit to for services as well as state and federal you at one point or another. assistance, the Heart Centre is depen- Why should I become a member of dent on this financial support. the Friends of the German Heart Cen- tre Foundation? Since its establishment, the Founda- tion has provided over 4.2 million Euro Cardiovascular disease in the indus- for the acquisition of new equipment, trialized nations is still the number organisation of medical congresses, one cause of illness and death. One distribution of scientific publications, of every two individuals in Germany surgery at no cost for those unable to will at one time or another develop afford it, and accommodations for fa- some type of cardiovascular disorder. mily members of hospitalised patients. This means that you, a member of In collaboration with the departmen- your family or a friend or aquaintance tal directors and management, the could become afflicted. In Germany Board of Directors decide on the most alone, cardiovascular illnesses are meaningful and cost-effective use of responsible for about 400,000 deaths the funds adhering to strict scientific each year. It is only through intensive and ecological considerations. The research, educational advertising, main body of the Foundation consists development of new medication and of a seven member executive board, treatment, that the mortality rate has who are responsible for the annual been lowered.

41 From A-Z A Dear patient, Accompanying family: The Ronald McDonald House is avai- This alphabetical index is to provide you with a helpful guide and information lable for the accommodation of pa- source during your stay at the Heart Centre. rents or relations, accompanying pae- diatric patients. Information on other Do not hesitate to ask questions, express your wishes or make suggestions. means of accommodation can be ob- tained in the wards or at the office of We wish you all the best and above all, a rapid recovery and good health the Head Consultant of the respective during your stay in our hospital. department. The social workers are also available with plenty of advice and Yours, Commercial Directorate information.

Admission: The admission of patients is done on the ground floor opposite the main entrance.

It is open from Monday to Thursday from 07:00 - 15:45 hrs and on Fridays until 13:30 hrs. Outside these opening hours, admis- sion is done directly on the wards. B Bank machine: A bank machine is in the entrance next to the cafeteria.

42 C D Coffeeshop: Drinks: Drinks, snacks, magazines and routi- The supply of drinks is an integral part Food/ Menu: nely needed articles may be purcha- of our service in our hospital. You will Our aim is to offer you a high-grade sed here. The coffee shop is located in be supplied with the type and amount and above all, variable range of deli- the vicinity of the main entrance. of drinks appropriate to your health. cious food. Please do not forget that In case you wish and are allowed to the diet eventually prescribed for you The opening hours are: drink something else, you may pur- during your stay may differ from your from Monday to Friday chase this at the coffee shop on the usual eating habits. The menu is valid 06.30 – 17.00 hrs ground floor or from the beverages for one week and is released on Sun- Saturday 09.00 – 10.00 hrs machine (in basement), after paying days. It can be found either in the 13.00 – 17.00 hrs the desired drinks. rooms or on the information board of Sunday 13.00 – 17.00 hrs the wards.

Room service possible: F Phone: +49 (0) 89 1218-1035 Fellow patients: H We endeavour to place „suitable“ Hairdresser: Counseling and training: patients together in the same room. An appointment can be made, through The following counselling services Naturally, that does not always work the nursing staff, with a hairdresser areavailable: out, so we ask for mutual respect, who comes to the hospital. @ Dietary advice for patients by dieti- consideration and understanding cians can be obtained through the during your stay in hospital. Hospital volunteer service: heads of the individual wards A volunteer service, called „Green La- @ AG Self-control of anticoagulation dies“, will be at your service to assist (ASA) Appointments can be obtained in minor errands or whenever you need through: someone to talk to. Inform the nursing Telephone: +49 (0) 89 1218-1012 staffs on your ward or leave a message @ Genetic counseling. Information on at the information desk on the ground this subject can be obtained from floor, whenever you wish to use the the heads of the individual wards services of these volunteers.

43 I P Information: Parking spaces: Physiotherapy: The Information desk can be found Unfortunately, there are only a limi- The department of physical therapy in the vicinity of the main hall and is ted number of parking spaces in our provides invaluable care especially in at your disposal with all necessary short-term parking space which is not providing excellent post-operative information. free-of-charge. therapy and treatment. A highly moti- vated team of physiotherapists works Internet: Patient rooms: at the German Heart Centre. As a special service, the DHM [Ger- The patient rooms are modern double- man Heart Centre Munich] offers you, bed rooms. Every room has a combined as our guest, free Internet access for shower and water closet. A cupboard R use with your own private terminal and a safe is also available for your Radio: device, provided such use is compati- personal effects. Space is limited, The transmission facility installed in ble with your medical treatment. kindly bring only your most necessary the hospital is made to serve as a belongings to the hospital. The Ger- source of information and entertain- man Heart Centre cannot be liable for ment. The nursing staff will explain M your valuables or cash. We offer how- how to use the radio to you. Mails/ Letters: ever the option of depositing valuables Kindly ensure that no one is disturbed. There is unfortunately, no letterbox in in the hospital safe. The nursing the hospital. You may handover fran- staffs will gladly inform you with the Road description: ked mail to the nursing staffs or at necessary details. See graphical road map page 48/ 49 the information desk on the ground floor.

44 S Self-help groups: and +49 (0) 89 1218-1040. @ You may also leave a message for Self-help groups have emerged for In co-operation with the public social the minister at the information. different groups. Information on the welfare department, the social ser- @ Church services are held every range of offers or assistance can be vices department provides help and Monday at 14.30 hrs in the worship obtained from the relevant depart- advice on: room in the atrium on the ground ment. floor. Information materials on the self- @ Arranging follow up treatment help groups can be found on the @ Rightful entitlements wards. @ Handicap registration T Taxi: Smoking: Spiritual welfare and Church service: The cost of using taxis for trips to and The German Heart Centre is a „non- @ A catholic hospital minister works from the hospital is assumed by the smoking“ hospital. Smoking is not in our establishment and visits the patients. Your health insurance will permitted in the entire building. patients regularly. His office is loca- inform you about reimbursement op- ted on the ground floor in the atrium tions. Taxis may be ordered through Social services: and can be reached under: the information. Social services can be found on the Telephone: +49 (0) 89/1218-1036 ground floor, room 0-116 beside the or email: [email protected]. Coffeeshop. @ The protestant hospital minister It can be reached under: can be requested to visit the house Telephone: +49 (0) 89 1218-1037 on demand, through the information.

45 T Telephone: Television: Visiting hours: If you have no telephone at your bed- Patient rooms are fitted out with tele- Visiting hours vary from ward to ward. side, there are two public telephones visions sets which can be used free-of- Nursing staffs will provide precise in- (coin telephone, card telephone) in charge. Kindly ensure that your fel- formation on visiting hours. In excep- the atrium on the ground floor at your low patients agree with your usage of tional cases, visiting hours may be disposal. the television at all times, and that restricted by the physician or when a You may of course be given a bedside no one is disturbed. Do not forget the medical or nursing procedure may re- telephone for a daily charge of € 2.30. rest periods and use a headphone if quire visitors to leave the room. We For this purpose, you will be given a necessary to avoid disturbing others. ask for your co-operation. card which you may load for making Children under the age of 14 are not calls, on the charging device on the allowed to visit the children‘s ward. ground floor beside the paediatric out- V Children are permitted in the general patient department or on the 2nd Floor Valuable personal effects: wards and the intensive-care units only opposite to the elevator. Kindly obser- Valuable personal effects may be de- after consultation with the physician ve the „Information on the usage of posited if necessary, at the cashier‘s treating the patient concerned. patient telephone“, which you receive office. It is located at the entry lobby on admission. (also see „Hospital rooms“).

46 Numbers of patients and procedures

Number of Cardiovascular Operations Number of Open-Heart Procedures Number of inhospital patients Number of Open-Heart Procedures in children 11.000 3.200 3.000 10.000 2.800

9.000 2.600 2.400 8.000 2.200 7.000 2.000 1.800 6.000 1.600 5.000 1.400 1.200 4.000 1.000 3.000 800

2.000 600 400 1.000 200 0 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Cardiac Catheterisation in adults Cardiac Catheterisation in children Electrophysiological Procedures

5.500 1.900 5.000 1.800 1.700 4.500 1.600 1.500 4.000 1.400

3.500 1.300 1.200 3.000 1.100 1.000 2.500 900 800 2.000 700 1.500 600 500 1.000 400 300 500 200

0 100 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

47 How to reach us

The German Heart Centre Munich is situated in Lazarettstraße 36 in 80636 München, i.e. in the heart of Munich.

You can reach us quite easily by car, rail, air or public transport:

By rail

Take the underground train Line U1 from the train station, to the train stop Maillingerstraße or take the Tram number 20 or 21 to Hochschule Lothstraße. From here, the remaining distance is only a few minutes on foot.

By air

There is an S-train from the Franz-Josef- Strauss airport to the main railroad sta- tion. From there, take the underground train line U1 to the train stop of Maillinger- straße or take the Tram number 20 or 21 to Hochschule Lothstraße. From here, the remaining distance is only a few minutes on foot.

By public transport

Take the underground train line U1 to the train stop of Maillingerstraße

Tram number 20 or 21 to Hochschule Lothstraße

By car

Lazarettstraße can be accessed directly from Nymphenburger Straße or Dachauer Straße. There are a limited number of parking spaces in front of the house.

48 A 95 from the direction of Garmisch Take the Garmisch highway A95 heading for Munich till the end of the highway. Take a left at the Central Ring West. Follow the central ring till the bridge of Donnersberg is left behind. Exit the ring shortly before entering the tunnel and take a right into Nymphenburger Strasse in the direc- tion of the city centre. In Nymphenburger Strasse, take a left into Lazarettstrasse (4th street).

A 96 from the direction of Lindau Take highway A96 to the direction of Munich until the end of the highway, this leads automatical- ly to the central ring West. Follow the central ring until the bridge of Donnersberg is left behind. Exit the ring shortly before entering the tunnel and take a right into Nymphenburger Strasse in the direction of the city centre. In Nymphenburger Strasse, take a left into Lazarettstrasse (4th street).

A 8 from the direction of Stuttgart Take the highway A8 in the direction of Munich till the end of the highway. Enter the traffic circle and take the 3rd exit. Continue to follow Verdistraße. Along the line, Verdistrasse becomes Ama- lienburgstrasse which in turn also becomes Menzinger Strasse and finally ends up as Notburga- strasse. Take a left at the Roman square. Follow the street until it ends up automatically, in Nymphenburger Strasse. Take a left in Nymphenburger Strasse into Lazarettstrasse (4th street).

A 9 from the direction of Nuremberg Take the highway A9 in the direction of Munich until the end of the highway and follow the central ring West in the direction of Lindau or Garmisch-Patenkirchen. From the central ring, take a left into Nymphenburger Strasse, take a left again into Lazarettstrasse.

A 92 from the direction of Deggendorf At the highway junction AK Neufahrn/68/Eching-Ost change over from A92 to A9 in the direction of Munich. Proceed to the end of the highway and follow the central ring West in the direction of Lindau or Garmisch-Patenkirchen. At the central ring, take a left into Nymphenburger Strasse in the direction of the city centre, take a left again into Lazarettstrasse (4th street).

A 94 from the direction of Passau Take the A94 until the end of the highway, this leads automatically to the central ring West. Follow the central ring until the bridge of Donnersberg is left behind. Exit the ring shortly before entering the tunnel and take a right into Nymphenburger Strasse in the direction of the city centre. In Nymphenburger Strasse, take a left into Lazarettstrasse (4th street).

A 8 from the direction of Salzburg Take the A8 in the direction of Munich-Giesing until the end of the highway, this leads automati- cally, to the central ring West. Follow the central ring until the bridge of Donnersberg is left behind. Exit the ring shortly before entering the tunnel and take a right into Nymphenburger Strasse in the direction of the city centre. In Nymphenburger Strasse, take a left into Lazarettstrasse (4th street).

49 Information on the Internet

You will find more information about the German Heart Centre Munich, the departments and institutes, your hospital stay and much more.

Visit our internet site at: www.dhm.mhn.de

50 Contacts

German Heart Centre Munich Commercial Directorate Lazarettstraße 36 80636 München Commercial Director: Germany Robert Siegert

Telefon: +49 (0) 89 1218-0 Telephone: +49 (0) 89 1218-1701 Fax: +49 (0) 89 1218-3053 Fax: +49 (0) 89 1218-1703 [email protected]

Department Department of Heart and Department of Cardio-Vascular Surgery Circulatory Diseases of Paediatric Cardiology and Medical director of DHM Deputy director of DHM Congenital Heart Disease Director of the Department: Director of the Department: Director of the Department: Prof. Dr. Rüdiger Lange Prof. Dr. Heribert Schunkert Prof. Dr. Peter Ewert

Telephone: +49 (0) 89 1218-4111 Telephone: +49 (0) 89 1218-4011 Telephone: +49 (0) 89 1218-3011 Fax: +49 (0) 89 1218-4113 Fax: +49 (0) 89 1218-4013 Fax: +49 (0) 89 1218-3013 [email protected] [email protected] [email protected]

Ambulance: Ambulance: Telephone: +49 (0) 89 1218-4005 Telephone: +49 (0) 89 1218-3005

Institute Institute Institute for Radiology for Anesthesiology for Laboratory Medicine and Nuclear Medicine

Director of the Institute: Director of the Institute: Director of the Institute: Prof. Dr. Peter Tassani-Prell Dr. Siegmund Lorenz Braun Dr. Stefan Martinoff

Telephone: +49 (0) 89 1218-4611 Telephone: +49 (0) 89 1218-1011 Telephone: +49 (0) 89 1218-4511 Fax: +49 (0) 89 1218-4613 Fax: +49 (0) 89 1218-1013 Fax: +49 (0) 89 1218-4513 [email protected] [email protected] [email protected]

Nursing Directorate

Director of Nursing Care: Burkhard Köppen

Telephone: +49 (0) 89 1218-1001 Fax: +49 (0) 89 1218-1003 [email protected]

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