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The Paediatric Heart Surgery Department is one of the oldest in Spain, with more than 5,000 operations performed with extracorporeal circulation and more than 40 years of activity behind it. We are a national reference centre for the treatment of congenital heart disease, and can offer surgery for all kinds of diseases.
The pathologies we treat at our Department all present with their own specific traits. This means the simplest forms of heart disease can happen while presenting hardly any symptoms. In contrast, the most complex forms appear during the neonatal period in the form of heart failure and cyanosis (lack of oxygenation).
According to official data, about 500 children with congenital heart disease are born in Spain a year, of which 60% of cases will require surgical treatment within the first year of life. These are the most common congenital malformations that occur in 8 out of every 1,000 births.
For a basic diagnosis of congenital heart disease, echocardiographies, electrocardiograms and chest X-rays are performed. There are cases where diagnosis with other imaging tests must be used, such as magnetic resonance imaging and computed axial tomography (CAT scan), stress tests or other more invasive methods, such as heart catheterisation, where a catheter is inserted into the cardiac cavities, and electrophysiological studies, where a puncture is made into the femoral vein, and one or more catheters are inserted.
These pathologies usually require an operation. This is why we have a high-tech operating theatre that allows intra-surgical monitoring, with anaesthetists and specialist nursing staff. As for primary prevention, though there is not much information on what can be achieved, a series of measures can be taken, such as control of maternal diabetes and rubella vaccinations, and, during pregnancy, avoiding exposure to teratogens, such as alcohol or thalidomide.
Outstanding professionals in these pathologies include Dr Raúl Abella, Dr Joaquín Fernández Doblas and Dr Joaquín Pérez Andreu. The work carried out by paediatric cardiac surgeons is supported by Paediatric Cardiology, Anaesthesia, Perfusion and Surgical Nursing. Support from intensive care units, both neonatal and paediatric, where all of our patients, are treated, is essential.
We have several specific areas of excellence that place us at the forefront of paediatric cardiac surgery. We run the following programmes:
Some congenital heart diseases require surgical correction during the first month of life. We have specific neonatal programmes, such as the univentricular heart programme, left cavity hypoplasia and pulmonary atresia.
We have extensive experience performing Ross surgery (valvular autograft), even in the neonatal period.
We support all patients suffering from severe cardiac issues. We are part of the ECMO programme (Extra Corporeal Membrane Oxygenation) that offers comprehensive life support to the patient. We are one of the most experienced hospitals in Spain in ventricular assistance programmes.
We are one of the hospitals in Spain with the highest number of transplant patients. Since 2006, we have carried out more than 50 heart and lung transplants.
Hypoplasia of left cavity is one of the most complex congenital heart diseases (Norwood operation). We have a hybrid room equipped with the right instruments to carry out combined procedures.
Pulmonary atresia with ventricular septal defect is one of the most complex heart diseases. In the most serious cases, there is severe hypoplasia of these pulmonary arteries, meaning the blood reaches the lungs through arteries from the aorta. We treat this pathology from the neonatal period to obtain the best results in the long term.
The Gynaecological Oncology and Lower Genital Tract Pathology Unit is a part of the Gynaecology Department. It treats all genital cancer diseases in the Hospital's catchment area, as well as more complex cases with requirements that exceed the capacity of other health centres in Catalonia.
Our mission is to provide effective, efficient and quality healthcare in the treatment of diseases. Our guiding principle is comprehensive care, where treatment, teaching and research combine to offer the public the highest quality competitive service.
We treat complex pathologies that require multidisciplinary care in which professionals from different disciplines work together. The future of gynaecological oncology pathology is promising, and we have excellent results: between 80% and 90% of cases are resolved with non-invasive surgery, be it laparoscopic, robotic or vaginal. This helps improve the quality of life of our patients.
We work to continue making progress, not only in the care we provide, but also in basic research, which will ultimately improve the care our patients receive. Our mission is for the Gynaecological Oncology and Lower Genital Tract Pathology Unit to lead the way as a cutting-edge centre of excellence with the latest technology, both within the Hospital and in the Catalan public health system as a whole.
Our Unit is one of the most active in the country, and is a reference in gastroenterology, that is, the digestive system, both as part of the Catalan Health Service and the Catalan Health Institute (ICS) and the rest of Spain, where we lead several educational and research projects.
Our centre’s Paediatric Gastroenterology Unit was founded in the early 70s by Dr Ramon Tormo, who was joined soon after by Dr Dámaso Infante. Together, they were pioneers in Paediatric Gastroenterology in Spain, and for more than three decades they consolidated this unit as one of the most recognised and prestigious nationwide.
Now it is known as the Gastroenterology, Hepatology, Nutritional Support and Paediatric Hepatic Transplant Unit, and is a reference centre for treating children with gastroenterological (digestive), hepatic (specifically liver and biliary tract) and/or nutritional illnesses.
Our Unit provides care for patients in the catchment area of Vall d'Hebron University Hospital, as well as taking over highly complex cases or patients that exceed the capacity of other hospitals, in both Catalonia and the rest of Spain.
The gastroenterology area is a multidisciplinary unit, dedicated to providing specialist, comprehensive, personalised care for patients affected by gastroenterological diseases, whatever the seriousness or number of cases among the general population. With more than 35 years of experience and a proven vocation for constant innovation in diagnosis and treatment, we continue to be pioneers in paediatric gastroenterology in Spain.
The multidisciplinary Hepatology Unit focuses on the needs of patients receiving liver transplants as well as patients affected by severe liver disease. With more than 25 years of experience, this unit is a pioneer in hepatic transplants in Spain, carrying out the first liver transplant in Spain in 1985.
It is now one of the most active units nationwide, and is a reference centre for liver transplants in children at the national level (CSUR). The unit treats children with severe liver disease and provides specialist, comprehensive, personalised care.
The multidisciplinary Nutritional Support Unit, which is a part of the Transversal Nutritional Support Unit, works together with the Paediatric Gastroenterology Unit, treating all patients with special nutritional requirements (those affected by oncological diseases, nephropathy, complex heart disease, solid organ transplants (spinal cord, liver, kidneys, etc.), congenital metabolic defects, etc.).
In addition to providing comprehensive, specialist support, the unit has run a Home Artificial Nutrition programme since 1998, both enteral (by tube) and parenteral (intravenous), which applies nutritional support procedures to stable patients in their own homes, enabling them to leave the hospital and improve their quality of life.
This unit is also responsible for patients with Short Intestine Syndrome, which is part of the intestinal rehabilitation programme, whose main objectives are to maintain the nutritional status of patients and promote the intestinal adaptation of the remaining intestine. This programme has extensive experience in prolonged Parenteral Nutrition (management of central lines, infusion systems, family training, etc.) and paediatric digestive surgery (autologous reconstruction techniques, that is, using the patient’s own tissue) of the intestines, including STEP and Bianchi intestine-stretching techniques) of the kind that child patients require.
Our team consists of: a coordinator, Oscar Segarra; attending physicians, Marina Álvarez, Jesús Quintero, Javier Juampérez, Susana E. Redecillas and Raquel Núñez; Primary care colleagues specialising in this specialty at COAP Sant Andreu - Casernes, Rebeca Corral and Toni Muntaner; Nurses, Carmen Arenas and Lis Vidal. Also, as part of the Master’s in Paediatric Gastroenterology 2017: Maria Mercadal and Cinthia Virginia Flores.
Thanks to our multidisciplinary team, with the collaboration of the staff and infrastructure of the General Hospital for adults, we can provide highly specialised, comprehensive medical and surgical attention to all patients who require it.
The Unit regularly participates in studies and clinical trials. All these are approved beforehand by the centre’s Clinical Research Ethics Committee. The main lines of research are based on the application of new techniques and procedures that allow us to make improvements in the short, medium and long term in the diagnosis and/or treatment of certain pathologies:
As a specialised reference unit, the Paediatric Gastroenterology Unit is responsible for significant teaching activity:
The main objective of the Pharmacy Department is the safe and efficient use of medication with the utmost excellence. Our Department supports care activity and is recognised as a collaborating centre of the Institute for Safe Medication Practices (ISMP), thanks to our role in preventing medication errors.
Our Department offers a consolidated portfolio of services, and we have a pharmaceutical team that monitors all registered prescriptions and pharmaceutical treatments.
We are responsible for distributing, dispensing and preparing medications with automatised systems and robotics, with one of the most significant technological systems in Europe. We use a system of drug-use indicators based on case histories to assess use of medication. This helps us detect opportunities for improvement, both in terms of security and reducing variability in clinical practice, meaning avoiding differences in the way our staff prescribe treatments.
The Department enjoys ISO 9001-2008 certification, which specifically covers prevention of medication errors. We have established a quality policy aimed at satisfying the needs and expectations of patients, and providing the services that contribute to improving quality of care through personalised attention for effective, efficient and safe drug treatment, while improving our systems.
Our main objective is to ensure our Department continues to contribute value to patients, bearing in mind the conditions at any given time in the Hospital, the Catalan Health Institute and the Catalan Health System in general. For this reason, between 2009 and 2015 we followed a strategic plan that uses the Balanced Scorecard methodology. This strategic plan takes into account new scenarios, social changes and emerging trends, which all necessitated a thorough review of our methodology, in a spirit of critical creativity and continuous improvement.
Rapid evolution in concepts and technology has resulted in the Pharmacy Department receiving several awards and honourable mentions for our clinical innovation and excellence.
The Thoracic and Airway Surgery Unit is part of the Paediatric Surgery Department, and emphasises the treatment of congenital pulmonary malformations of the thoracic wall through the application of minimally invasive orthopaedic surgery techniques in selected cases.
Our unit coordinates a multidisciplinary team for treating paediatric airways. We have a great deal of experience in the treatment of infections due to pus accumulated in the lungs (complicated parapneumonic empyema). We coordinated the first multicentre trial published in the world, meaning a clinical trial with several research centres or hospitals and with randomised patients, to compare video-assisted thoracoscopy with treatment with fibrinolytic drugs.
The treatments we offer are the following:
At the Plastic Surgery and Burns Department, we treat diseases of the whole human anatomy and specialise in transplant techniques for the face and extremities, tissue regeneration and reparative microsurgery and more. Constantly striving for innovation, we are a pioneering Department internationally in total facial transplants and stem cell treatment of burn scars.
Constantly striving for innovation, the Plastic Surgery and Burns Department was a pioneering service internationally in total facial transplants and stem cell treatment of burn scars.
At the Plastic Surgery and Burns Department, we handle congenital or acquired diseases that affect soft tissue and bone, traumatisms and large burns, as well as specialising in face, limbs, grafts, treatment of tumours and significant deformities and regeneration of tissues and reparative microsurgery, and more.
We treat diseases that require the use of plastics and tissues in the form of flaps and biomaterials. For these treatments, we often use advanced wound healing, microsurgery and endoscopy techniques. We treat the whole body, but focus on the face, the skull and the neck, as well as the torso, in particular the mammary glands, and the extremities, especially the hands and the legs.
Our main objective is reparatory surgery. We specialise not only in techniques for transplants of the face and extremities, but also in biomaterials and tissue regenerators, adult stem cells and reparative microsurgery.
With over 50 years of history, Plastic Surgery and Burns Department is a leading centre in severe burns and a Spanish Reference Centre (CSUR) for complex reconstruction of the auricle, microtia, face and hand treatment and stem cells and major catastrophes. Tragedies such as the Hipercor terrorist attack and the fire at the Els Alfacs campsite are examples of this.
Plastic surgery is highly focused on hospital services and is a multidisciplinary specialty, characterised by constant innovation, the relationship with other specialties and the constant search for excellence. We were pioneers internationally in total facial transplants and in treatment with stem cells for burn scars.
Our Department is home to many functional units, and we participate in various multidisciplinary teams from other specialties; the Burns Unit, the Microtia and Facial Malformation Unit, the Breast Pathology Unit and the Face and Extremities Transplant Unit are all worthy of mention.
Neonatal Surgery is the sub-discipline within paediatric surgery that deals with surgically treating congenital and acquired illnesses in newborns and infants up to one month old.
This is a highly complex sub-speciality that only exists at tertiary paediatric centres. The past few decades have brought about important advances, thanks to improvements in diagnostic techniques, neonatal intensive care and anaesthetics, and surgical techniques and materials. These have radically changed the prognosis for both birth defects and acquired surgical pathologies in newborns.
Neonatal surgery requires detailed knowledge of complex pathologies in patients who also have special conditions that are different from other paediatric patients. The Neonatal and Foetal Surgery Unit covers practically every surgical neonatal pathology, and it is a reference centre both nationally and on a European level. It is part of ERNICA, the European Reference Network (ERN) for Rare Inherited and Congenital Digestive Disorders. In recent years, the Unit has been firmly committed to introducing minimally invasive surgical techniques, achieving excellent results.
We work in conjunction with the Neonatology Department. The Neonatal Intensive Care Unit (NICU) at Vall d’Hebron Hospital is one of the largest in the country and has one of the best survival rates. We have the possibility of performing surgical interventions within the NICU if transporting the newborn patient to the surgical wing would be too risky due to the instability of their condition.
Similarly, we work closely with the Foetal Medicine Unit, whose services include all the currently valid prenatal and intrapartum (EXIT technique) foetal surgery techniques.
The Unit participates in the following sessions and committees: Neonatal Medical-Surgical Session (Tuesdays at 1 pm), Paediatric Airway Committee, Birth Defects Committee.
Within our areas of interest, we highlight oesophageal atresia, a pathology for which our overall survival rate exceeds 95% in patients who do not present complex associated malformations. Patients with long-gap oesophageal atresia continue to be a challenge, as the distance between the ends is so great that a primary repair cannot be done. In these complex patients, besides applying the different classic techniques, we use the Foker technique, which consists of sustained traction on the ends to be connected in order to stimulate their growth, so that oesophageal anastomosis can finally be achieved. In those patients for whom the native oesophagus cannot be saved, we carry out oesophageal substitution via gastric pull-up, with excellent short-term and long-term results.
We have established a comprehensive treatment plan for patients affected by a congenital diaphragmatic hernia (CDH), which includes foetal treatment (using the FETO technique: Foetal Endoscopic Tracheal Occlusion) in cases where CDH has been diagnosed in the foetus and the prognosis is not good. In addition, the hospital offers every type of invasive and non-invasive respiratory support and therapy available today: synchronised mechanical ventilation, HFOV, CPAP, treatment with inhaled nitrous oxide, and ECMO (extracorporeal membrane oxygenation), providing cardiovascular and respiratory support when conventional treatment proves ineffective. In patients with large diaphragmatic defects, we use several types of patches, both synthetic and biological ones, and techniques that use autologous muscle flaps, generally from the abdominal wall.
The main abdominal wall defects we find are gastroschisis and giant omphalocele. We are especially proud of how we handle gastroschisis, which can be associated with severe medical-surgical problems due to the inflammation and thickening of the exposed intestinal loops caused by the irritation produced by the amniotic fluid at the end of gestation. Since 2002, we have been carrying out a strategy to avoid this, consisting of performing a scheduled Caesarian section at 34-35 weeks of gestation. This elective preterm C-section technique allows for the abdominal defect to be closed directly, as it reduces exposure to amniotic fluid. With more than 50 patients treated this way, we have not observed complications linked to prematurity. Instead, we have detected a decrease in the associated complications, an earlier introduction to food, and a reduced hospital stay, as well as better aesthetic outcomes, since the scar is hidden by the belly button. We have vast experience in treating giant omphalocele. For this, we use surgical techniques that employ vascularised flaps, biologic or synthetic mesh, and vacuum-assisted closure (V.A.C.®).
Our overall survival rates for acquired surgical pathologies such as necrotising enterocolitis and intestinal perforation (both in premature and LGA premature - with a birth weight of less than 750g - babies) is comparable to other European reference centres. This is thanks to the application of our philosophy of minimally aggressive surgery and conservative treatment; applying these principles is the underlying reason for our high rates of survival and preservation of native intestine.
Intrauterine or peripartum surgery
Pathologies of the disgestive tract
Pathologies of the abdominal wall
Pathologies of the lungs and respiratory tract
Others
The Paediatric Maxillofacial Surgery Unit is proud of its extensive experience in the treatment of complex cranioencephaly malformations. We should also highlight the treatment of paediatric maxilofacial tumours.
Our team is made up of paediatric surgeons who are a part of the Paediatric Surgery Department, and surgeons from the Oral and Maxillofacial Surgery Department.
One example of the work our team carries out is the application of nasoalveolar modelling (NAM) technique to treat children suffering from cleft lip and palate. This treatment is incorporated in the protocol of comprehensive treatment offered to such patients at our centre. This helps surgeons and improves the aesthetic and functional results of reconstructive surgery, as it reduces the severity of the deformity and can easily be carried out in the consultation in a way that is safe and pain-free.
At the Hepatobiliary and Pancreatic Surgery and Transplant Department, we dedicate ourselves to hepatic (liver), pancreatic and biliary surgery, as well as cancer surgery. This mainly involves surgery related to the surgical and onco-surgical treatment of tumours or liver metastases, liver and bowel transplants in children and adults, and intestinal transplants. Our Children’s Liver Transplant Programme is the only one of its kind in Catalonia, and one of just five in Spain. Our excellent results make us a national leader.
The Hepatobiliary and Pancreatic Surgery and Transplant Department is highly specialised, and is independent of the General Surgery Department, which is not very common in general surgery departments. We are organised into two sections: one section devoted mainly to liver surgery and liver and intestine transplants, and another aimed at pancreatic surgery and advanced laparoscopic surgery.
Vall d'Hebron was the first health centre in Spain to carry out a paediatric liver transplant in 1985. With more than 30 years of accumulated experience acquired since the first transplant was carried out, the hospital is home to an amazing group of professionals: anaesthetists, intensivists, radiologists, gastroenterologists, hepatologists and more, all trained to treat the most complex cases with very high survival rates. This survival rate is more than 90% at five and six years after the transplant. We are deeply proud that we have been able to achieve such figures.
To do so, and to offer the best service to our patients, we work closely with other hospital departments, mainly with Internal Medicine and Hepatology, Intensive Care, Oncology, Gastroenterology, Radiology and Pathological Anatomy.
At the Paediatric Intensive Care Unit of Vall d'Hebron University Hospital, we provide life support treatment. We treat patients who, when an organ fails, require specific treatment to replace that organ’s function. We are a leading reference ICU for congenital heart disease, solid organ transplants, neurocritical patients, burns and spinal cord injuries.
Our mission as a paediatric ICU is to take care of children's health, through effective, efficient and quality health care in the treatment of diseases.
More specifically, our objectives are:
To achieve these goals and treat children with specific illnesses and different physiological conditions, a highly qualified team and innovative technology are essential for us to adapt to the reality of each specific case.
Paediatric Intensive Care professionals require specific training. All our staff are highly qualified to recognise signs of serious conditions and the complications that might go with them, as well as being able to decide the correct doses for treatments. The combined expertise of our team is the key behind the prestige the Paediatric Intensive Care Unit enjoys internationally.
The Paediatric ICU is open to families. Not only do the parents and children accompany their baby, but so do the brothers and sisters through the Siblings Project, a pioneering project that began in 2014 at the request of a child who wanted to see his brother who had been admitted.
Both families and patients can benefit from the Sol Solet Programme, where we organise an ICU outing to sunbathe as a family. Nothing is left to chance on these outings.
Our Paediatric ICU came to life in 1968, and was the first in Spain. Nowadays, it is a specialised area where we have the most innovative technologies to allow us to apply advanced therapies for children who need specific life support treatment.
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