ENDOPROSTHETICSORTHOPAEDICS / CARDIOLOGY

ASKLEPIOS NEWSLETTER Issue 2/2017

Photo: Fotolia Fabio Balbi

Dear Readers, Clinic operator Asklepios

The heart is a very special organ and much hospitals. Some hospitals far exceed even Asklepios is one of the largest operators of more than a hollow muscle that pumps this level and are among the best in Europe private clinics and healthcare facilities in blood through the body. and in some cases the world. Here we help Germany. Founded more than 30 years ago, to develop and research new techniques the chain of clinics follows a responsible In Germany and numerous other countries which later all hospitals can benefi t from. and sustainable strategy geared towards a and cultures, the heart is closely associated high level of safety and quality. The group with feelings. This is not wholly wrong as In this newsletter, we present three of these currently has more than 150 healthcare it reacts very sensitively to stimuli to the hospitals with exceptional cardiology units. facilities spread across Germany between autonomic nervous system. the Island of Sylt on the North Sea and Wishing you the best of health! Lindau by Lake Constance and employs Heart disease can take an acute and very more than 46,000 staff. In the 2015 fi scal dramatic course, but it can also begin in a Faithfully, year, Asklepios treated around 2.3 million gradual fashion. At Asklepios, the patients. treatment of heart disease has been one the core skills of our hospitals for many Medical quality management at the years. Cardiac treatment of the highest Dr Thomas Wolfram, highest level is an area in which Asklepios standard is kept at the ready in all our Chairman of Asklepios Kliniken GmbH particularly excels. The clinic operators benefi t from the group’s structure to promote knowledge transfer between the facilities and to provide particularly excellent treatment. The results are also published regularly. For instance, the Medical Findings Report is published annually at www.qualitätskliniken.de of which Asklepios is a charter member. Moreover, 25 criteria on patient safety are published regularly on the Internet.

Photo: Fotolia peshkova

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CARDIOLOGY

Treating heart failure in good time — in the Asklepios Clinic in Harburg

Cardiac insufficiency or heart failure is one of the most frequent causes of death in industrial countries. More than 20 million people around the world suffer from this serious illness which is characterised by the heart's inability to pump sufficient blood. As a result, the body is not supplied with enough oxygen, and patients complain increasingly of fatigue, shortness of breath, dizzy spells, constant coughing, swollen ankles and legs as well as water reten- tion around the abdomen. Heart failure is usually caused by a different heart disease: In the case of a heart attack, inflammation of the heart muscle, coronary heart disease or hardening of the arteries, heart muscle tissue is destroyed and replaced by scar- ring with the result that the muscle can Photo: Fotolia psdesign1 no longer pump properly. Doctors speak of insufficiency at stages NYHA III and NYHA and her team attach great importance to systolic heart failure. Diastolic heart failure, IV are treated here every year by a team of detecting structural heart disease as early on the other hand, is often caused by high experienced cardiologists under the lead- as possible and giving the appropriate blood pressure or damaged blood vessels ership of Chief Physician Dr. Britta Gold- therapy before the heart grows even weaker. due to diabetes: The heart muscle tenses mann. Cardiologists, heart surgeons, lung Because the earlier this occurs, the more and is no longer able to relax. However, and kidney specialists, vascular surgeons doctors can do for their patients. both forms of heart failure lead to the same and many other specialist departments symptoms: shortness of breath on exertion. work hand in hand here to cover all aspects Contact of heart failure and to offer the latest Dr. Britta Goldmann Anyone suffering from heart failure needs treatment methods — from elaborate drug Chief Physician at the Department of to receive the right treatment as quickly therapies administered under supervision Cardiology as possible as this can extend life expec- in intensive care, via special pacemakers Tel.: 040 181886-2830 tancy by around ten years. In every fourth (CRT, ICD, CCM) to the correction of heart Fax: 040 181886-3427 case, the heart even recovers completely if valve defects by catheter (MitraClip, TAVI) [email protected] treated quickly, whilst it is unable to regain or heart operations performed in the hybrid its old strength if the disease is already operating theatre. There is also a high- Asklepios Klinikum Harburg advanced. The severity of heart failure tech support system, the Impella® pump Eißendorfer Pferdeweg 52 is divided into four stages in accordance available for the temporary treatment of 21075 Hamburg with the guidelines issued by the New York acute heart failure. This complete range of www.asklepios.com/hamburg/harburg/ Heart Association (NYHA), based on the equipment coupled with the experience of experten/kardiologie complaints experienced: NYHA I (initial our renowned experts have resulted in more heart failure with no symptoms) to NYHA IV and more patients with heart insufficiency (difficulties even when resting). being sent to Hamburg-Harburg to be cared for, even from distant hospitals. The diagnosis and treatment of heart failure is one of the main areas which the Askle- Even if most patients treated for heart pios Clinic in Harburg, Hamburg focuses insufficiency in the Asklepios Clinic in Har- on. More than 2,000 patients with heart burg are already seriously ill, Dr. Goldmann

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CARDIOLOGY / HEART SURGERY

Repairing defective heart valves by means of a catheter

It was only a few years ago that anyone suffering from a constricted or leaky heart valve would sooner or later have to face up to a major heart operation. But an opera- tion of this nature involving the use of a heart-lung machine is much too stressful and dangerous for many older or seriously ill patients. In many cases, defective heart valves can now be repaired or even re- placed inside a beating heart — in a gentle procedure using a catheter. Defective aortic valves, above all, are being more and more frequently replaced by high-tech pros- theses introduced by catheter in the groin in a folded state and deployed and anchored Photo: Fotolia Monkey Business at their implantation site (TAVI procedure). anatomies can vary significantly. The progress the so-called "Heart Team", and the various Leaky mitral valves are treated by means made in valve technologies and the growing treatment options are explained to them. of various catheter procedures: Either the experience amassed by the doctors have The Heart Team consists of cardiologists, tips of the two valve leaflets are joined with steadily expanded the areas of application heart surgeons and cardio-anaesthetists who a clip (MitraClip), or a ring is fitted around for minimally invasive procedures in the last perform the TAVI procedures together in the enlarged mitral valve to make the open- few years. While catheter-based procedures two special hybrid operating theatres in the ing smaller. were initially reserved for high-risk patients clinic. It is crucial for the patient's safety, for whom open-heart surgery would be particularly with these modern techniques, Specialists at the Cardiovascular Centre in too dangerous due to their age or poor that the cardiologists are supported by an the Asklepios Clinic in St. Georg, Hamburg, condition, these gentle procedures have experienced heart surgery department such are among the pioneers of these techniques, now also proven themselves for younger as that run by Prof. Dr. Michael Schmoeckel and they participate in numerous interna- patients without any serious associated at the St. Georg Asklepios Clinic, which is tional studies intended to refine them. The illnesses. In one of the first centres in the ready to spring into action in the event of heart valve programme using the MitraClip world, the heart specialists at the St. Georg complications. was launched here in the Cardiology De- Asklepios Clinic are now also tackling the partment under the leadership of Prof. Dr. catheter-based repair of the tricuspid valve Contact Karl-Heinz Kuck in 2008, and a short time for which there were previously no gentle, Dr. med. Christian Frerker later techniques for treating defective aorta catheter-based treatment options whatever. Head of Interventional Valve Therapy, valves were added. The experts making This heart valve with three flaps directs the Valve Consultations up this interdisciplinary team under the blood from the right atrium into the right Tel.: 040 181885-2033 leadership of Senior Physician Dr. Christian ventricle and is often leaky in patients with Fax: 040 181885-3869 Frerker can now look back on more than heart failure. The result is that patients [email protected] 1,800 TAVI and more than 800 MitraClip suffer from an accumulation of fluid in their procedures. In 2015, the clinic was one legs and abdomen and shortness of breath. Asklepios Klinik St. Georg of the first TAVI centres to be certified by Lohmühlenstraße 5 the German Cardiac Society. Besides their Close collaboration between cardiologists 20099 Hamburg vast experience, the heart specialists in the and heart surgeons is becoming more www.asklepios.com/hamburg/ clinic have an extensive arsenal of different and more important to ensure that each sankt-georg/experten/kardiologie/ types of prostheses at their disposal with patient is treated using the best possible herzklappenerkrankungen the result that they can select a perfect techniques for them personally. In the fit for every patient. This gives them a St. Georg Asklepios Clinic, every patient crucial advantage as sometimes patients' requiring a new heart valve is discussed in

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CARDIOLOGY / HEART SURGERY

Curing cardiac arrhythmia arrhythmia. These cells are switched off by Atrial fibrillation: Ablation leads to means of targeted ablation, thus curing the control of the heart's rhythm — with a catheter arrhythmia. The introduction of computer The most frequent cardiac arrhythmia is systems has significantly reduced patients' atrial fibrillation which occurs in sudden If the heart repeatedly misses a beat, this is exposure to radiation associated with radi- attacks (paroxysmal). Here the normal rhyth- very stressful for the person concerned and oscopy and at the same time made naviga- mical contraction of the heart is suspended in many cases it is associated with a high tion of the catheter in the heart more and when the atria of the heart no longer have risk of suffering a stroke. Although cardiac more precise. The specialists in Schwalm- the strength to pump the blood into the arrhythmia can usually be kept in check stadt can now control their catheters to an ventricles due to extra beats. The origin of with drugs, this means taking pills for one's accuracy of two millimetres which has again these extra beats lies in the pulmonary veins whole life — and sometimes not even pills significantly improved the success of their where pathologically altered cells generate will help. Interventional cardiorhythmolo- treatment. electrical pulses and relay them to the atria. gy now offers alternative treatments that This is particularly dangerous because the are often more successful in controlling Too fast a heartbeat can almost always blood backs up in the atria and blood clots the heartbeat than drugs and the effect of be successfully treated can form in the so-called atrial auricle, an which is also permanent. The team led by Up until a few years ago, cardiac arrhyth- appendage of the right atrium, and these Dr. Matthias Schulze and Dr. Elvan Akin in mia with a significantly higher pulse rate clots can at some point be washed into the the Schwalmstadt Asklepios Clinic special- could only be treated with drugs which brain with the bloodstream and there trigger ises in the modern catheter procedures of could only be used to a limited extent due a stroke. Here, too, catheter procedures can interventional rhythmology, and also uses to their side-effects. The catheter proce- help to solve the problem: So-called pulmon- special pacemakers (ICD, CRTD) for treating dures employed today in the Schwalmstadt ary vein isolation leads to lasting rhythm congenital or acquired, non-reversible dis- Asklepios Clinic permit cardiac arrhythmia control in around 70 percent of cases, and ease of the heart muscle. to be cured permanently in many cases — a normal sinus rhythm is achieved. Drugs without drugs and their side-effects. The are only successful here in 30-40 percent of Modern computer technology for more success rate for so-called AV nodal reen- cases. If a patient is suffering from perman- successful treatments trant tachycardia which occurs frequently, ent atrial fibrillation, catheter ablation may Above all, the progress made in computer stands at 98 percent, for example. Catheter also make sense — although here several technology has inspired modern catheter procedures for treating atrial flutter and interventions are often required to achieve procedures, frequently facilitating new "WPW syndrome" which is characterised the goal of long-term rhythm control. treatment techniques that are now offered by an additional electrical pathway in the in Schwalmstadt. Supercomputers are used heart, enjoy similar levels of success. In the Contact to evaluate a flood of electrical signals from case of so-called focal atrial tachycardia or Chief Physician Dr. Matthias Schulze the surface of the skin and from inside the ventricular arrhythmia, the success rate is Tel.: 06691 799-646 heart, generating three-dimensional images 80 percent which although somewhat lower [email protected] that show the specialists the way to the dis- is nevertheless far superior to treatment by Chief Physician Dr. Elvan Akin eased heart muscle cells responsible for the drugs. Fax: 06691 799-321 [email protected]

Asklepios Klinikum Schwalmstadt Central Office of General Internal Medicine/Cardiology and Rhythmology/Electrophysiology Krankenhausstraße 27, 34613 Schwalm- stadt

Photo: Fotolia 4designersart

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Centres of cardiac treatment with particular expertise

Sylt

Langenhorn Volksdorf

Steilshoop Barmbek Osdorf Eppendorf Winterhude Ostseebad Trassenheide Rissen Wandsbek St. Georg Altona Horn Neustadt Hamm Bad Schwartau Bad Oldesloe Elmshorn Wilhelmsburg Crivitz Hamburg Waren (Müritz) Pasewalk Neugraben/Fischbek Plau am See Harburg Seevetal/Meckelfeld Geesthacht Parchim

Schwedt

Soltau Bad Bodenteich

Birkenwerder Lingen Rathenow Teltow Schönefeld OT Hannover* Brandenburg/Hv. Potsdam Waßmannsdorf Werder Königs Bad Münder Ludwigsfelde Wusterhausen Teupitz

Horn-Bad Meinberg Goslar Seesen Coswig Lübben Bad Harzburg Burg Höxter Clausthal-Zellerfeld Vetschau Cottbus Göttingen Bad Düben Essen Rosdorf Leipzig * Oschatz Neustadt in Weißenfels Radeberg Sachsen Bad Wildungen Melsungen Naumburg Hohenmölsen Sebnitz Reichshof-Eckenhagen Schwalmstadt Tabarz Gera Sankt Augustin Bad Salzungen Stadtroda Bonn-Dottendorf Pößneck Wildenfels Greiz Lich Butzbach Nidda Bad Elster Asklepios: acute-care clinic for somatic diseases Königstein-Falkenstein Bad Orb Wiesbaden Seligenstadt Langen Asklepios: specialist clinic for psychiatry Bayreuth Bad Sobernheim Asklepios: post-acute/rehab clinic Alsbach-Hähnlein Bad König Oberviechtach Asklepios: other healthcare facilities St. Wendel Schwandorf (including day-care hospital, psychiatric outpatient clinics (PIA), Blieskastel Bad Rappenau health centre, care facility) Germersheim Burglengenfeld Cham Kandel Bad Kötzting Kelheim Bad Abbach Facility under management Schaufl ing Gernsbach Achern Aidenbach Durbach Offenburg Bad Griesbach MediClin: acute-care clinic for somatic diseases Bad Peterstal-Griesbach MediClin: specialist clinic for psychiatry Lahr MediClin: post-acute/rehab clinic Triberg Königsfeld Gauting Donaueschingen Bad Tölz MediClin: other healthcare facilities Bad Bellingen Lenggries Lindau (Bodensee) (including day-care hospital, health centre, care home) Photo: Asklepios

Asklepios Klinikum Harburg Asklepios Klinikum Schwalmstadt See also:

■ Dr. Britta Goldmann ■ Dr. Matthias Schulze Treating Heart Failure Tel.: 040 181886-2830 Tel.: 06691 799-247 Prof. Dr. Jochen Müller-Ehmsen, Chief Physician [email protected] [email protected] for Cardiology, Asklepios Klinik Altona www.youtube.com/watch?v=E3CQd_GCACU&index= 1&list=PLhKoyZAFkGBvAcxXBkcrENTkY1ZGzvOQV Asklepios Klinik St. Georg ■ Dr. Elvan Akin Tel.: 06691 799-646 Cardiac Arrhythmia ■ Dr. Christian Frerker [email protected] Priv.-Doz. Dr. Gerian Grönefeld, Chief Physician Tel.: 040 181885-2033 for Cardiology, Asklepios Klinik Barmbek [email protected] www.youtube.com/watch?v=g2cn7R1_u_I& index=3&list=PLhKoyZAFkGBvAcxXBkcrENTkY1ZGzvOQV

Connection between Heart Disease and Strokes Privatdozent Dr. Alexander Ghanem, Ltd. Senior Physician for Cardiology, Asklepios Klinik St. Georg www.youtube.com/watch?v=FJ-t5IeQ_Fs&index=16&list= PLhKoyZAFkGBvAcxXBkcrENTkY1ZGzvOQV

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