ENIn interventional cardiology, the cardiologist treats the heart from inside a blood vessel, through a puncture in the wrist or groin, guided by X-ray images and usually under local anaesthetic. Much that once required opening the chest is done this way.
This page covers interventional cardiology in Germany for coronary artery disease, valve disease and structural defects: the procedure, who it suits, when surgery is better, the departments and the arrangements. The overall picture is on the cardiology in Germany page.
Coronary Angiography and Stents
Coronary angiography shows where an artery is narrowed and by how much: contrast dye injected through the catheter makes the heart’s arteries visible on X-ray. If a critical narrowing is found, a stent, a small mesh scaffold that holds the artery open, can be placed in the same procedure.
Access is through the wrist or groin. If the images leave it unclear how much a narrowing restricts blood flow, a thin wire with a sensor compares the pressure before and after it; intravascular imaging, an ultrasound or optical probe on the catheter, shows the artery wall and plaque from inside. Both help decide whether a narrowing really needs a stent.
Complex cases include chronic total occlusions (long-standing complete blockages), several narrowings and heart attacks. For high-risk procedures, devices support the circulation: the Impella, a small pump passed along an artery into the heart, or ECMO, a machine pumping and oxygenating blood outside the body. Whether bypass surgery is the better option is decided by the heart team of cardiologists and cardiac surgeons; see the bypass surgery page.
Valve Treatment Without Opening the Chest
TAVI is aortic valve replacement by catheter: the new valve travels to the heart along an artery and opens inside the old one. In Germany a narrowed aortic valve is now replaced by catheter far more often than by open surgery.
When the mitral or tricuspid valve leaks, its leaflets no longer close tightly. In selected patients, mainly those for whom surgery is too risky, the valve is repaired by catheter, for example with a clip brought in through a vein that holds the leaflets together.
Suitability for TAVI depends on age, the risk of open surgery and anatomy on CT, such as valve size and the vessels the catheter must pass. The heart team of cardiologists and cardiac surgeons decides, as described in the German Cardiac Society’s pocket guideline on valve disease.
Closing Holes and Preventing Stroke
An atrial septal defect (ASD) or a patent foramen ovale (PFO) is closed with a small “umbrella” brought by catheter through a vein and opened on both sides of the hole. ASD closure is considered when so much blood crosses the defect that the right heart is overloaded. A PFO, a passage between the upper chambers left open after birth in some people, is considered for closure mainly in younger patients after a stroke with no other cause found.
In atrial fibrillation, an irregular heart rhythm, clots can form in the left atrial appendage, a small pouch of the heart, so closing it by catheter is considered for some patients who cannot take anti-clotting drugs. If a thickened septum, the muscular wall between the ventricles, obstructs blood outflow and medication does not help, alcohol septal ablation (TASH) is considered: alcohol injected by catheter into a small septal artery thins the thickened area. Ablation for rhythm disorders is also a catheter procedure, covered on the arrhythmia treatment page.
Preparation, the Procedure and Recovery
Preparation starts with documents: ECGs, echo reports, earlier angiography on disc, CT scans and a medication list, especially blood thinners. Recent kidney tests matter too: if kidney function is reduced, contrast dye can harm the kidneys, so preparation is planned in advance.
On the day and afterwards, heart rhythm, blood pressure and the puncture site are monitored; the site is closed with a pressure dressing or a wrist band. At discharge the doctor explains when normal activity can resume and decides when flying is safe. Where indicated, cardiac rehabilitation follows.
Frequently asked questions
What is the difference between angioplasty and stenting?
Angioplasty widens a narrowed artery with a balloon; stenting leaves a mesh scaffold there to keep it open. Usually both happen in one procedure. Whether a stent is needed is decided from the angiography and, if required, a pressure measurement inside the artery.
Is angioplasty painful?
Usually not. The puncture site is numbed with a local anaesthetic, and the catheter is hardly felt inside the vessels. You stay awake. Brief chest pressure or pain can occur while the balloon is inflated; tell the doctor at once. General anaesthesia is rarely needed.
Which medicines are needed after a stent?
You usually need two drugs that stop clots forming on the stent: aspirin plus a second drug that makes platelets less sticky. The cardiologist sets how long, depending on the stent, the diagnosis and the bleeding risk. Never stop them on your own, even before dental treatment or another operation.
When can I fly home after angioplasty?
The doctor decides after checking the puncture site, heart rhythm, blood tests and how you feel. After a planned procedure through the wrist this usually comes sooner than after a heart attack or complex intervention. Book flexible tickets and carry the discharge letter in your hand luggage.
How AlenMed Arranges Interventional Cardiology in Germany
At ISAR Klinikum Munich, Prof. Alexander Leber heads the ISAR Heart Centre: stents via the wrist, TAVI, ASD and PFO closure, left atrial appendage closure and TASH. At Helios Klinikum München West, Prof. Sebastian Kufner heads cardiology and internal intensive care: complex coronary interventions, intravascular imaging, ECMO and Impella. At München Klinik Bogenhausen, chief physician Dr Sebastian Rogowski leads structural heart disease care, including TAVI. At the German Heart Center at Charité in Berlin, Prof. Ulf Landmesser, a specialist in interventional cardiology and valve interventions, directs cardiology, angiology and intensive care at Campus Benjamin Franklin; the centre runs one of Europe’s largest TAVI programmes by case numbers. At Helios Klinikum Erfurt, Prof. Alexander Lauten heads cardiology: TAVI and catheter treatment of tricuspid regurgitation. Partner clinics are across Germany; AlenMed’s office is in Munich.
We pass images and reports to the interventional cardiologist, obtain an assessment and cost estimate, and arrange the visa, pickup, accommodation and an interpreter. The hospital invoices you directly. Back home, we help you stay in touch with your treating doctor.
This material is for reference only and is not an offer. The heart team decides between a catheter procedure and surgery after an in-person examination.
News on this topic
European CE Mark Approval Granted for da Vinci 5 in Cardiac Surgery
The da Vinci 5 system has received CE marking in Europe for adult cardiac interventions, expanding minimally invasive coronary bypass and thoracoscopic procedures in Germany.
ACS Pathfinder approved as a medical device to support heart attack diagnosis
Developed at UKE with support from DZHK, the ACS Pathfinder algorithm has received CE certification and a European patent for rapid, precise heart attack rule-out.
Inhaled mosliciguat shows clinical promise in pulmonary hypertension
Phase 2 PHocus trial results demonstrate significant hemodynamic and functional progress with inhaled mosliciguat in patients with PH-ILD.
