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Cardiovascular Surgery
German Heart Centre Munichof the State of Bavariaand the Technical University Munich
Clinic for
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PublisherClinic for Cardiovascular SurgeryGerman Heart Centre Munich
Press OfficerProf. Dr. med. Rüdiger LangeDr. med. Paul Libera
Design and Layouticom new mediaIckstattstrasse 1680469 München
PhotographyDHMicom
1st edition September 2005
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The German Heart Centre
Outstanding contributions
The Clinic for Cardiovascular Surgery
Areas of expertise
Coronary bypass surgery
Beating heart surgery
Heart transplantation
Aortic valve surgery
Heart valve repair
Thoracic aortic surgery
Minimally invasive mitral valve surgery
Minimally invasive aortic valve surgery
Minimally invasive radial artery harvesting
Minimally invasive paediatric cardiac surgery
Endoscopic surgery
Non-invasive treatment of aortic aneurysms
Congenital heart surgery
Ebstein’s disease
Minimally invasive pulmonary valve placement
Quality assurance
Contact us
Table of Contents
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The German Heart Centre, Munich (DHM) at the Technical University of Munich is one of the most modern specialised centres in Germany for the treatment of cardiovascular disease in adults and children. The free State of Bavaria is the responsible body for this hospital. Three highly specialised clinics (the Clinic for Cardiovascular Surgery, the Clinic for Cardiovascular Disease and the Clinic for Paediatric Cardiology and Congenital Cardiac Defects) as well as three institutes (the Institute of Anaesthesiology, Radiology and Nuclear Medicine and the Insti-tute of Laboratory Medicine) are all located at a single facility.
The German Heart Centre Munich
Outstanding achievements
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of the Clinic for Cardiovascular SurgeryOutstanding achievements
@ First successful heart transplant in
Germany on May 7th, 1981
@ First totally endoscopic mitral valve repair with the aid of the “Da Vinci”
telemanipulator in 2000
@ Introduction of mammary artery anastomosis in Germany
@ Setup of a homograft bank for pro-
cessing human valves
@ Advancement of extracorporeal cir- culation
@ Surgery by means of a telemanipu- lator (“robotic surgery”)
@ Development of new procedures to
preserve heart transplants
@ Development of a new centrifugal pump for the heart-lung machine
@ Pilot clinic for the development of
quality assurance in cardiac surgery
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State of the art cardiac surgeryAs well as being the largest centre for the treatment of congenital cardiac defects in Germany, the Clinic of Cardiovascular Surgery of the German Heart Centre Munich is a global leader in the treatment of acquired heart defects (bypass and heart valve surgery etc.). Prof. Dr. Rüdiger Lange has been the director of the clinic since 1999.
The Clinic for Cardiovascular Surgery
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Prof. Dr. Rüdiger LangeDirector of the clinic
The entire spectrum of cardiac surgery is performed here, ranging from infant surgery, valve repair procedures, coronary artery revascularisation and surgical repair of the large intrathoracic aorta to heart transplants and artificial heart.
Approx. 47,000 cardiovascular operations, 12,000 of which were in children, have been performed in the Clinic for Cardiovascular Surgery since its establishment over 30 years ago.
State of the art cardiac surgery
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@ Bypass surgery@ Heart valve operations@ Combined bypass and valve surgery@ Multiple valve replacement@ Minimally invasive surgical procedures@ Off-pump surgical procedures, i.e. without heart-lung machine (OPCAB)@ Heart transplants and artificial heart@ Surgical procedures with the aid of the telemanipulator (“robotic surgery”)@ Repair of congenital heart defects in every age group@ Heart surgery in premature infants, neonates and children@ Surgery of cardiac tumours@ Vascular surgery (e.g. aneurysm surgery)@ Endovascular stent implantation of descending aorta@ Pacemaker surgery@ Arrhythmia surgery
All areas of expertise
Heart-lung machine
of the Clinic for Cardiovascular Surgery
Dr. Paul Libera
Personal Consultant of the Clinic Director
Heart valve outpatients:
Priv.-Doz. Dr. Walter Eichinger
speaking to a patient
Heart tumour removal
Ventricular aneurysm
Intensive care bed at the Clinic
for Cardiac Surgery
2,874 congenitalcardiacdefects, ofthose:283 without heart-lung machine
2,591 with heart-lung machine
96others
46 tumours
46heart transplants/ Novacor/ BerlinHeart
5,362bypass surgery (isolated& combined)
2,787operations without heart-lung machine
333aorta
2,238valves
13,782operationsGermanHeartCentreMunich,1999-2004
The entire spectrum of cardiac surgery is performed here, ranging from infant surgery, valve repair procedures, coronary artery revascularisation, surgical repair of the large intrathoracic aorta to heart transplants and artificial heart.
The graph shows the enormous increase in the number of patients attending the Clinic for Cardiovascular Surgery during the past 31 years. In 2004, there were, for the first time, 2,000 patients who underwent surgery with a heart-lung machine.
2,000
1,800
1,600
1,400
1,200
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On-pumpsurgicalproceduresGermanHeartCentreMunich,1974-2004
Numberofpatients
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Approx. 2,600 surgical procedures are performed in our clinic annually. They are made up as follows:@ 2,000 on-pump surgical procedures, 450 of which are on-pump in children @ 200 patients are less than one year old@ 550 off-pump surgical procedures
Approx. 2,600 surgical procedures annually
The cardiac surgical department can accommodate a total of 55 patients round the clock, providing state of the art medical care.
In addition, the Clinic for Cardiovascu-lar Surgery has a large experimental laboratory at its disposal (head of which is Priv.-Doz. Dr. R. Bauernschmitt) in which numerous projects are carried out, such as: @ the development of an automatic heart-lung machine @ tissue engineering @ experimental and clinical examina- tion of heart valves@ development of new technologies for surgical robots and @ development of a heart replacement pump
Our scientists work closely with our clinicians, thus ensuring an exceptio-nally high level of scientific efficiency.
Optimal medical care
Scientific efficiency
Duration of postoperative hospital stayGerman Heart Centre Munich, 2004split into various surgical groups
Isolated bypass surgery
Aortic valve
Bypass with aortic valve
Bypass with mitral valve
Mitral valve repair
Mitral valve replacement
Aortic valve with mitral valve
Bypass with aortic and mitral valve
Mitral valve with tricuspid valve
Aortic valve with tricuspid valve
Aortic, mitral and tricuspid valve
Tricuspid valve
Isolated ascending aorta
Bypass with ascending aorta
Bentall’s procedure
Bentall’s procedure with bypass
Other operations
Cardiac tumour
Bypass and other surgical procedures
Median in days
12 10 8 6 4 2 0
On-pump surgical proceduresGerman Heart Centre Munich, 2004
1,811
1,272
456
83
1,641
182
399
60
1,664
1,211
402
51
1,691
1,144
438
116
1,998
1,426
454
119
1999 2000 2001 2002 2003 2004
Acquired cardiac defects (first operation) Acquired cardiac defects (re-operation)
Congenital cardiac defects Total
1,735
1,210
452
74
Num
ber o
f pat
ient
s
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Surgical treatment of acquired cardiac defects
German Heart Centre Munich 1.8 % with heart-lung machine 0 % without heart-lung machine
Coronary bypass surgery
Dr. Norbert Mayr
Arteriosclerotic cardiovascular di-sease continues to be the most com-mon cause of death in Germany and other industrial nations. At the German Heart Centre Munich, coronary bypass surgery makes up about 40% of all surgical procedures.
Complete arterial revascularisation with in-situ use of both thoracic ar-teries (LIMA, RIMA) as well as of the radial artery is the procedure of choice in state of the art bypass surgery. The long-term patency rates of the arte-rial grafts are far superior to those of the great saphenous vein. The radial grafts and saphenous vein transplants are removed in a minimally invasive or endoscopic procedure.
in Germany 2.8 % with heart-lung machine 1.9 % without heart-lung machine(source: DGTHG)
in the USA2.4 % with heart-lung machine
(source: STS)
Mortality associated with isolated on- and off-pump bypass surgery in 2004
13
Off-pump surgery:
Bypass surgery on the beating heart
Beating heart surgery (off-pump)
Beating heart surgery represents a further development in the surgical treatment of coronary arteries.
A heart-lung machine is not required for this procedure. A stabilising device is used in the area of anastomosis to restrict movement of the heart, and the heart can be positioned by means of a suction cup.
Dr. Bernhard Voss
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Heart transplants
Donor heart (left) and anastomosis of the large vessels (pulmonary artery and ascending aorta)
between donor and recipient (right)
Since the mid eighties, the orthotopic heart transplant has been accepted as the procedure of choice in the treatment of refractory terminal heart failure.
This procedure was successfully performed for the first time in Germany at the German Heart Centre Munich on May 7th, 1981. Today, heart transplantation is performed regularly at our clinic. The international one year survival rate is higher than 80% while the five year survival rate is higher than 60%.
Surgical treatment of acquired cardiac defects
123456789101112131415161718
HearttransplantsActuarialsurvivalrateworldwide
100
80
60
40
20
0Surv
ival
in%
Yearsfollowinghearttransplants (Source: ISHLT)
Artificial heart (Berlin Heart)
Artificial heart systems, such as the left ventricular Assist Device (Novacor) or the biventricular Assist Device (Berlin Heart) are also being used as a bridge-to-trans-plant.
Artificial heart systems
IsolatedaorticvalvereplacementGermanHeartCentreMunich,1995-2004
Mortality (2004)German Heart Centre Munich 3.0 %Federal Republic of Germany 3.4 % (Source: DGTHG)
USA 3.4 % (Source: STS)
200
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01995199619971998199920002001200220032004
Mechanical valve Biological valve
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019941995199619971998199920002001200220032004
BypasssurgerywithaorticvalvereplacementGermanHeartCentreMunich,1994-2004
Mortality (2004)German Heart Centre Munich 4.7 %Federal Republic of Germany 6.2 % (Source: DGTHG)
USA 6.1 % (Source: STS)
Numberofpatients
Numberofpatients
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Aortic valve surgery
Priv.-Doz. Dr. Walter Eichinger
Prof. Rüdiger Lange: “Aortic valve surgery is the most com-mon procedure performed in the area of aortic surgery. The aortic valve is usually too tight or is leaking and needs to be replaced by a biological or mechanical artificial valve. Aortic valve defects may be congenital or brought about, for examp-le, by a protracted infection where bacteria stick to the valve and destroy it. However, the cardiac surgeon also operates on dilatations (aneurysms) and tears (dissections) of the main thoracic arteries.”
Aortic valve replacement with biological prosthesis (left) and
with mechanical prosthesis (right).
Aortic valve replacement with stentless prosthesis
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Heart valve reconstruction („repair“)
Thanks to the development of new techniques, diseased valves can be “repaired” more and more, rather than being replaced (heart valve repair).
The procedure of heart valve repair requires highly experienced, specially trained surgeons and is therefore only performed in large cardiac surgical centres, such as the German Heart Centre Munich.
Surgical treatment of acquired cardiac defects
Director of the clinic
Prof. Dr. Rüdiger Lange
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Mitral valve repair with re-
placement of tendinous chords
All techniques for valve-sparing
mitral valve repair are performed
at the German Heart Centre Munich.
Mitral valve repair. Here: Quadran-
gular resection P2 of the posterior
leaflet with placement of an half
open annuloplasty ring.
Mitral valve repair and mitral valve replacementGerman Heart Centre Munich, 1991 - 2004
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0
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Mitral valve repair
Mitral valve replacement
Num
ber o
f pat
ient
s
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Surgical treatment of acquired cardiac defects
The German Heart Centre Munich is also one of the leading centres in Germany in the field of thoracic aor-tic surgery.
If the aortic valve ring is significantly dilated, combined with the presence of a pathological aortic valve, a valved conduit (tube prosthesis with inte-grated heart valve prosthesis) is fre-quently implanted. The coronary ostia
Thoracic aortic surgery
are anastomosed end-to-side with the prosthesis, thereby being re-imp-lanted (Bentall’s procedure).Today, a valve-sparing procedure is the method of choice where possible, especially if the aortic valve exhibits no macroscopic structural changes. However, this surgical technique ismore demanding from a technical point of view and requires a high level of surgical experience.
Valve-sparing surgery saves the pa-tient from the need of anticoagulants or later valve prosthesis replacement. Apart from that, the haemodynamics of the patient’s own valve are always more favourable than those of a valve prosthesis.
Pronounced aneurysm of the descending aorta.
3D demonstration in CT picture (left) and equivalent intraoperative findings (right)
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Yacoub procedure:
Aortic valve-sparing surgi-
cal technique used in the
treatment of aneurysms of
the ascending aorta
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80
60
40
20
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1999 2000 2001 2002 2003 2004
Total
Ascending aorta
Aortic arch
Descending aorta
Surgery of the aortaGerman Heart Centre Munich, 1999 - 2004
Num
ber o
f pat
ient
s
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Keyhole surgery is being applied more and more in the field of cardiac surgery in specialised centres, such as the German Heart Centre Munich.
A technique that is not only advantageous for the patient from a cosmetic point of view, but is also a contributing factor to the success of surgery. Only few cen-tres in Germany have offered this innovative type of cardiac surgery to date.
Minimally invasive surgical procedures
Minimally invasive surgical incision
in mitral valve surgery
Minimally invasive surgery at the German Heart Centre
21
The Clinic for Cardiovascular Surgery of the German Heart Centre Munich is specialised in the technique of minimally invasive heart valve surgery, parti-cularly in mitral valve repair with minimal incisions of five to six centimetresin length extending from the right rib cage.
Minimally invasive mitral valve surgery
Cosmetic result following minimally invasive
mitral valve repair
22
Aortic valve replacement is also performed using keyhole surgery where possible. Only the upper half of the sternum is split for this procedure.
The incision is now a vertical incision in the middle of the chest measuring only about 6-8 centimetres instead of
Minimally invasive aortic valve surgery
Minimally invasive aortic valve replacement with small incision of only seven centimetres
Minimally invasive surgical procedures
20-30 centimetres in the traditional approach. When performed by experi-enced cardiac surgeons, the outcome is comparable with surgery involving a full sternotomy and complete opening of the rib cage. The advantages of key-hole surgery in aortic valve operations are considerable, particularly with regard to the healing process. Priv.-Doz. Dr. Joachim Weipert
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The sternum is much quicker to heal following only a partial sternotomy. Since only the top half of the sternum is now severed, the lower part stabi-lises the upper part in the postopera-tive healing phase. In this way wound healing disturbances can be avoided almost completely. Furthermore, post-operative pain, for example during
breathing is significantly reduced.A partial sternotomy rather than a full sternotomy is now also performed for surgery on the ascending aorta.
Since the introduction of these new techniques in 2000, nearly every fifth operation in the German Heart Centre is now performed using keyhole surgery.
24
Minimally invasive surgical procedures
The radial artery and the saphe-nous vein are commonly used as bypass vessels. It is possible to use keyhole surgery for these pro-cedures.
Endoscopic harvesting of the radial artery and the saphenous vein in bypass surgery
A skin incision of approx. three cen-timetres (instead of the usual 25-30 centimetres) is required. Harvesting is performed by means of an endo-scope.
This method offers considerably better cosmetic results with a smaller wound area than the conventional method, while ensuring graft quality for its use in bypass surgery.
Cosmetic outcome following minimally invasive
radial artery harvesting
Endoscopic harvesting of the saphenous vein
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Surgeons at the German Heart Cen-tre Munich have developed a further innovative minimally invasive tech-nique for the repair of atrial septal defects.
The surgical occlusion has already been performed in children via an incision through the ribs on the right chest in order to spare patients a large vertical scar on the sternum. However, this technique has been advanced considerably.
Minimally invasive paediatric cardiac surgery
Prof. Lange: “It was not uncommon for such girls to later have differently sized breasts. This came about becau-se in prepubescent children it is im-possible to predict where exactly the breast will later develop. A larger sur-gical incision in this area may interfere with the development of breast tissue in puberty. We now avoid this problem by opening the rib cage from the side, practically just below the armpit. The breast tissue remains undamaged in this way and the breast can develop
normally. A scientific study performed in our clinic has proven this without doubt. The cosmetic result is sensa-tional.” This midaxillary muscle-sparing, right-sided thoracotomy has been available at the German Heart Centre Munich for over one year now for all prepubescent patients suffering from atrial septal defects.
Atrial septal defect: The midaxillary muscle-sparing, right-sided thoracotomy in a
prepubescent patient
Atrial septal defect:
Cosmetic result fol-
lowing midaxillary
thoracotomy
26
Minimally invasive surgical procedures
Endoscopic surgery with the telemanipulator
Furthermore, the German Heart Centre Munich has a telemanipulator (robot) at its disposal for special surgical procedures. The German Heart Centre Mu-nich was one of the first hospitals worldwide to use a telemanipulator system for endoscopic cardiac surgery.
The first totally endoscopic mitral valve repair, i.e. without opening the rib cage, to be performed worldwide was carried out in 2000 at the German Heart Centre Munich. Furthermore, a number of purely endoscopic bypass operations have been performed successfully by means of the telemanipulator.
In addition, the clinic is currently conducting clinical trials and experimental studies to establish new surgical techniques using a telemanipulator. The goal of such techniques is to perform valve-sparing surgery and valve replacement on a closed thorax via four to five small ports. To date, we have already operated on a large group of patients with the aid of a robot. Partial steps of newly plan-ned techniques have been applied and optimised during this time.
Priv.-Doz. Dr. Stephen M. Wildhirt
Application of a
telemanipulator
(“robotic surgery”)
27
Non-invasive treatment of aortic aneurysms
Interventional treatment of aortic
aneurysms:
inner vessel support of aorta
(aortic stent). It is placed by means
of a catheter via the femoral artery.
Various surgical procedures are ap-plied in the Clinic for Cardiovascular Surgery for the treatment of disorders related to the large intrathoracic artery (aorta). Among other procedures, so-called stents (inner vessel supports) have been implanted for several years now. The rib cage does not need to be opened for their positioning nor does the patient need to be attached to a heart-lung machine.
Priv.-Doz. Dr. Robert Bauernschmitt
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Surgical treatment of congenital cardiac defects
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0
Surgery of congenital cardiac defects in GermanyAge of children M 1 year old
1 2 7 12 15 20 21 23 27 37 40 48 49 55 56 59 66 67 68 74 76 89 108
113
115
146
165
182
German Heart Centres arranged according to number of on-pump operations in ascending order
German Heart Centre Munich
Source: E. Bruckenberger, Herzbericht, 2003
Heart of an infant, weight at time of surgery 2,600 grams
Num
ber o
f pat
ient
s
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The Clinic for Cardiovascular Surgery specialises in particu-lar in the treatment of congenital cardiac defects.
Performing 550 surgical procedures annually in children, ado- lescents and adults with congenital heart defects, the clinic ranks among the leading international institutions in this field.
As a rule, complex congenital cardiac defects are repaired in the German Heart Centre Munich even in subjects weighing less than 2,000 grams.
The German Heart Centre Munich has a valve bank at its dis- posal in which human valves are freshly processed for implan- tation in children undergoing the commonly required pulmo-nary artery valve replacement in paediatric cardiac surgery.
Paediatric cardiac surgical team
Congenital heart defect surgery
Dr. Christian Schreiber
and Dr. Martin Kostolny
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Ebstein’s disease
Deputy director
Prof. Dr. Klaus Holper
Ebstein’s disease is a congenital heart defect in which the origin of the septal and/or posterior leaflet of the tricuspid valve is displaced in the right ventricle. Triscuspid valve insufficiency is the primary haemodyna-mic complaint.
The surgical technique developed at the German Heart Centre Munich (Monocusp patch with anterolateral displacement of the anterior leaflet) has made valve-sparing repair possible in 90% of patients suffering from Ebstein’s disease. The perioperative risk associated with this method is only slight, especially when compared on an international level. This reflects the safeness of the surgical technique. The majority of patients were in NYHA stage III prior to surgery. Long-term studies over a period of 30 years have revealed a significant improvement in nearly all patients in terms of their capacity for exertion (88 out of 90 patients in NYHA stage I or II). Further analysis has shown that early surgery is an essential factor in further reducing the morbidity and mortality rate as well as achieving a lasting improvement in the quality of life of such patients.
Surgical treatment of congenital cardiac defects
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Minimally invasive pulmonary valve placement
Dr. Christian Schreiber
The Shelhigh Injectable Pulmonic Valve represents a new possibility for patients after repeated surgery of the right ventricular outflow tract (RVOT).
The porcine valve, mounted in a self-expanding metal frame, was first implanted at the German Heart Centre Munich in April 2005. A young patient with the most severe form of pulmonary valve insufficiency, who had undergone Fallot’s repair in the past, underwent implantation of a stented valve with median sternotomy via the dilated RVOT.
Minimally invasive pul-
monary valve placement:
Preoperative preparations
(left) and proper positi-
oning of the Shelhigh
implant in the final X-ray
examination
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Quality assurance
Quality has always been of the utmost importance for the German Heart Centre Munich. As early as in the mid eigh-ties, the director at the time, Prof. F. Sebening, took up the
concept of quality assurance at a time when only few dealt with this subject.
Together with seven other hospitals, the Clinic for Cardiac Surgery took part in a
model project that was sponsored by the Ministry of Health. The aim of the project was to establish a quality assurance system for the entire area of cardiac surgery. One of the most comprehensive and successful schemes of external quality assurance in Germany emerged from this project.
All 87 hospitals and departments specialised in cardiac surgery participate in the scheme today and forward their records, featuring after all more than 300 characteristics, in anonymous format to a centralised location. This centre in turn analyses and compares all hospital data, after which each hospital is forwarded its own data in relation to the mean values of all other hospitals. A so-called hospital pro-file is thus produced, which shows us how we compare on a national level to other hospitals.
Every point represents a clinic for cardiac
surgery. The higher the number of sur-
gical procedures performed, the bigger
the points. The red point symbolises the
German Heart Centre Munich (data from
the German Heart Centre Munich only
for 2004, all remaining data from 1999 –
2004).
The green lines show the European mean
while the red line represents the versa-
tility of the centre.
The hospitals in the upper right field to
which the German Heart Centre belongs
perform more complex procedures com-
bined with better survival rates than the
European average.
30-day-survival in European comparison26,378 patients with congenital cardiac defects, EACTS Congenital Database 1999 – 2004
Complexity of surgical procedure
Surv
ival
rate
for 3
0 da
ys in
%
100
98
96
94
92
90
88
86
84
82
80
78
76
2.5 3.5 4.5 5.5 6.5 7.5 8.5 9.5 10.5
97.1%
94.0%
Dr. Michael Wottke
AgedistributionandnumberofpatientsGermanHeartCentreMunich,1975,1990,2004
Approx. 47,000 cardiovascular operations have been performed at the Clinic for Cardiovascular Surgery since its establishment 30 years ago. New techniques and scientific progress have made it possible to keep lowering the age at which congenital cardiac defects can be operated upon. Just as the age at which elderly patients can be successfully operated upon is constantly on the rise.
500
400
300
200
100
0
<1
1-9
10-1
9
20-2
9
30-3
9
40-4
9
50-5
9
60-6
9
70-7
9
80-8
9
90-1
00 1975 1990 2004
Heartsurgeryinpatientsover80yearsofageGermanHeartCentreMunich,1990-2004
Numberofpatients
Ageofpatients
140
120
100
80
60
40
20
0
19901992199419961998200020022004
Numberofpatients
500
400
300
200
100
0
Euroscore: lowestrisk mediumrisk highrisk highestrisk 0-23-56-9N 10
Number of patients Mean ICU stay in days Early mortality in %
1.6
0.8
2.2
1.6
4.0
3.1
26.4
6.5
Euroscore,ICUstayandearlymortalityGermanHeartCentreMunich,2004
On-pumpsurgery n Meanage Euroscore30-day-mortality[%]
Isolatedcoronarybypass 676 65.9 3.4 1.8
Isolatedaorticvalve 236 67.9 5.6 3.0
Coronarybypasswithaorticvalve 172 73.3 6.4 4.7
Mitralvalverepair 101 60.8 4.4 0
Ascendingaorta 95 59.0 7.0 1.1 (withandwithoutcoronarybypass)
Age,EuroscoreandmortalityGermanHeartCentreMunich,2004
Numberofpatients
33
We pay particular attention to the development of quality assu-rance in the field of paediatric cardiac surgery. We participate in the European paediatric cardiac data bank in Warsaw. As the leading hospital for paediatric cardiac surgery we also take part on a national level, together with our Clinic for Paediatric Cardiology and Congenital Cardiac Defects, in the setting up of the German “quality assurance for paediatric cardiology” within the scope of the Federal Office for Quality Assurance.
During our C&D conferences, illnesses are discussed that have not taken the expected course. Following a short description of the case, physicians discuss whether something could have been done to affect the clinical course more favourably.
Psychologist Dipl.-Psych. Ulrike von Wolffersdorff
during a counselling session
34
Contact us:at the German Heart Centre MunichLazarettstrasse 3680636 Munich
Telephone: +49 (0) 89 1218-4111 (day) +49 (0) 89 1218-3105 (night)Fax: +49 (0) 89 1218-4113
Secretariat of the Clinic for Cardiovascular Surgery
from left to right:
Astrid Plock, Claudia Lacher, Waltraud Scharff, Gülseren Taflan and Mira Ihrenberger
Clinic for Cardiovascular Surgery
�
A large children’s party was organised on September 13th,2003 to celebrate the 11,111th paediatric cardiac operation.
Patients from all over
the world: Prof. Lange at
the bedside of a small
patient from Tanzania
Back cover, top:
photo of Dr. Wael Bedda
and Mrs. Buschra Körber
�
Cardiovascular Surgery
German Heart Centre Munichof the State of Bavariaand the Technical University Munich
Clinic for
