Domaine du cœur

Mitral valves can be repaired without the need for substitution or replacement. In patients with mitral valve prolapse, our success rate in avoiding mitral valve replacement approaches 100% with very low risk

Bloodless heart surgery is transfusion-free cardiac surgery, where the patient’s wishes are respected based not only on religious beliefs but also with the intention of trying to avoid the potential risks associated with blood transfusions, such as infections, complications and mortality. Our bloodless cardiac surgery team has become an international benchmark in treating patients from all over the world

Traditional heart surgery typically requires exposure of the heart and its vessels through median sternotomy (dividing the breastbone) and a 6 to 8 inch incision. Minimally invasive heart surgery (also called keyhole surgery) is performed through small incisions, sometimes using specialized surgical instruments. The incision used for minimally invasive heart surgery is about 3 to 4 inches.

The benefits of minimally invasive techniques include:

• Small incisions and small scar.
• Shorter hospital stay after surgery.
• Low risk of infection.
• Less postoperative pain.
• Low risk of bleeding and blood transfusion.
• Shorter recovery time and faster return to normal activities/work.

Sutureless aortic valves, the alternative to traditional and transcatheter valves,were designed to simplify and significantly accelerate the surgical replacement of a diseased valve and first require complete excision of the calcified native valve. Shortening the time required for aortic valve replacement may help to reduce morbidity and mortality, especially in patients who require complex multivalve or combined valve and coronary procedures

The Ross operation is an extremely complex procedure developed for individuals who require a new aortic valve. In the Ross procedure, the diseased aortic valve is removed and replaced with the patient’s own pulmonary valve (autograft). After the pulmonary valve is transferred to the aortic position, a pulmonary homograft from a donor (human cadaver) valve is sewn into the pulmonary position, and the coronary arteries are re-mplanted. The Ross procedure is especially well suited to young individuals.

Advantages of the Ross procedure

• Anticoagulants (blood thinners, such as Warfarin) are not necessary. Blood thinners increase the risk of bleeding, and may lead to a stroke or other medical problems. In addition, blood thinners cannot be used in women who may become pregnant as they cause severe damage to an unborn child.
• Thromboembolic complications are near zero.
• The risk of endocarditis is reduced.
• The natural valve is superior in hemodynamics to prosthetic or bioprosthetic valves.
• The autograft has the potential to grow as the child grows (which artificial valves cannot do).
• Patients’ activities do not need to be limited.

Ross procedure candidates are:

• Infants
• Young people who are very active and do not want to take blood thinner medication for the rest of their lives
• Young women who want to become pregnant
• Middle-aged active people

Cardiac surgery is the only type of elective surgery where routine immediate extubation is not considered a routine procedure. Immediate extubation still challenges conventional practice; therefore, it should be performed in an environment where surgeons, perfusionists, nurses, and respiratory technician are all involved in this endeavor. We routinely extubate after cardiac surgery.

Why Do It? Positive pressure ventilation is not beneficial for recovery after cardiac surgery since it reduces the venous backflow, can make certain pulmonary complications such as pneumothorax or hemothorax worse.

Cause of cryptogenic strokes, often in younger patients

And closure of the left atrial appendage, aimed at patients at risk of embolic stroke due to atrial fibrillation, but who cannot follow an anticoagulant treatment due to high probability of haemorrhage.

Aimed at such a large group of patients with serious degenerative aortic stenosis, who are considered to be at high or prohibitive surgical risk, as well as an alternative therapy for patients at intermediate risk. We have been performing this type of operation weekly in our hybrid operating theatre.

For those patients with functional severe mitral regurgitation.

We have a prenatal diagnosis programme for both national and international patients; international patients are consulted through telemedicine. We have a Mother and Child Service with Obstetrics and Neonatology that is highly specialised in treating heart defects. All types of neonatal heart defects are treated, including those in premature and underweight babies. Extracorporeal circulation techniques are used, which are dedicated to maintaining organ perfusion, which guarantees low morbidity rates. A 7-day stay and approx. 96% survival rate.

• Hypoplastic left heart syndrome.
• Total anomalous pulmonary venous drainage.
• Hypoplastic aortic arch.
• Interrupted aortic arch.
• Truncus arteriosus.
• Pulmonary atresia.

Pulmonary atresia with ventricular septal defect (VSD) is a rare congenital heart defect. Highly complex and with a group 4 ABS, the main aim is to establish a single source of pulmonary blood flow, unifocalising the collaterals, closing the VSD and implanting a valved conduit between the RV and PA.

We are international experts, performing the 3 main types of procedure: 1) unifocalisation in the first year of life, 2) staged repair of PA, 3) repair of PA using hybrid procedures (Interventional Haemodynamics), depending on the anatomic type.

At the end of treatment, 90% of patients have VSD closure and a survival rate 96%. These results make us stand out at an international level.

Tetralogy of Fallot is a complex congenital heart defect that takes many forms and can be treated from neonatal age to adulthood.

The main aims are to establish sufficient pulmonary flow, VSD closure, and pulmonary valve preservation, using hybrid techniques of interventional catheterisation during surgery, which enables the dilation of the pulmonary valve annulus with a balloon, avoiding cutting it and enabling the preservation of the pulmonary valve, thus preventing the need of further operations in adulthood. In 95% of cases, we preserve the pulmonary annulus with a z score of -3.

It is the most common heart defect that requires surgical treatment at neonatal age.

Our centre performs an arterial switch in all patients with TGA regardless of their coronary pattern.

Complex TGA:

• TGA with VSD
• TGA with hypoplastic aortic arch and/or coarctation of the aorta (CoA) and
• TGA with pulmonary stenosis (PS)

We perform all kinds of techniques to anatomically correct this defect, including the Rastelli and Nikaidoh procedures for TGA, VSD and PS.

This is one of the challenges of the speciality, since suitably sized valve prostheses for small patients do not exist. At our centre, we are very experienced in performing aortic valvuloplasty for aortic stenosis in neonatal age. Different aortic and mitral valve reconstruction techniques are used in patients under one year old, with valve preservation with an average of 10 years without the need to re-operate.

The surgical team is one of the most experienced and has the best results at European level in the Ross and Ross-Kono procedures, including in infant and neonatal age patients.

Highly complex heart defects, where there is only one functional ventricle, and after various surgical treatments, patients end up having the Fontan circulation procedure. The surgical team was one of the pioneers in using the extra-cardiac Fontan procedure in Europe (C. Marcelletti procedure), gathering one the largest case studies. In cardiac malpositions, reconstruction of the tunnel with an intra/extra-cardiac conduit is used with very good results. This technique is performed in very few centres at present.

We have a highly specialised team of interventional haemodynamics specialists who, together with the surgical team, deal with all tributary conditions with this type of treatment. E.g. Apical VSD, stent insertion, pulmonary valve implants, among others.

Atrial fibrillation is the most common arrhythmia and is one of the largest causes of stroke, heart failure, sudden death and cardiovascular problems. It is a cardiac rhythm disorder that causes heartbeats to be irregular, inappropriately fast and not adapted to the needs of the body. This rhythm disorder results in the formation of, among other things, blood clots in the heart, which can produce embolisms in the brain and other organs.

It is estimated that in the year 2030, there will be between 14 and 17 million people with atrial fibrillation in the European Union, with between 120,000 and 215,000 new patients diagnosed each year.

The main complication is cerebrovascular accident (stroke), due to blood clots that form in the heart when it has atrial fibrillation, and which would not form if the arrhythmia was not present. Another significant complication is the development of heart failure, which occurs in 1 in every 3 patients diagnosed with atrial fibrillation during follow-up. Mortality is doubled in patients with both atrial fibrillation and heart failure.

Although it can be initially treated with anti-arrhythmia drugs, these do not cure it and only decrease the frequency of the attacks in some cases, but they cannot prevent them. Therefore, patients often opt for treatment through ablation. Ablation is a cardiac catheterisation, through which pulmonary veins are isolated. Ablation has better results that pharmacological treatment for preventing new episodes of arrhythmia.

Thanks to our research activity and the application of the latest techniques for treating ventricular arrhythmia, we can better identify patients who are at greater risk of sudden death among those who suffer from a structural heart disease or heart failure. Until now, when these patients underwent treatment for heart failure, a device was implanted, which can either work by only re-synchronising the heartbeats or, as well as re-synchronising, can defibrillate. However, the clinical criteria for deciding one option or another are quite vague, and this results in some patients not being sufficiently protected because they have an implant that can only re-synchronise.

However, this decision can be made in a much more precise way thanks to cardiac nuclear magnetic resonance. We are entering into what is called personalised and precision medicine. In this way, it is checked whether there is scar tissue on the heart and, if so, if it is very extensive. If so, the model with defibrillator is chosen, and if not, the simpler model is chosen.

It is not the only case in which resonance ends up being a determiner in the treatment of these patients. The procedure for performing an ablation in patients with ventricular arrhythmia is very complex and requires a lot of preparation. Now it is possible to carry out a resonance beforehand and, thanks to data post-processing, we can see the electrical channels in the scars. These channels are what sustain ventricular arrhythmia and being able to see them helps to make ablations quicker, easier to perform, and more successful.