Skip to main content
Erschienen in: Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 5/2020

02.09.2020 | Aortenklappeninsuffizienz | CME

Aortenklappenrekonstruktion

Von Improvisation zur Standardisierung

verfasst von: Dr. med. U. Schneider, Univ.-Prof. Dr. med. H.-J. Schäfers

Erschienen in: Zeitschrift für Herz-,Thorax- und Gefäßchirurgie | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die Rekonstruktion der insuffizienten Aortenklappe ist ein zunehmend praktiziertes Konzept zur Behandlung der angeborenen oder erworbenen Aortenklappeninsuffizienz. In der Form des klappenerhaltenden Ersatzes der Aortenwurzel kann das Konzept der Rekonstruktion auch beim Aneurysma der Wurzel angewandt werden. Mit einer adäquaten Stabilität der Rekonstruktion kann nicht nur eine Antikoagulation vermieden werden, sondern sie führt auch zu einer reduzierten Wahrscheinlichkeit klappenassoziierter Komplikationen und möglicherweise einem verbesserten Überleben. Der vorliegende CME-Beitrag geht auf Indikationsstellung und Auswahl von geeigneten Klappenpathologien ein. Grundlegende Konzepte, technische Aspekte und Resultate bei verschiedenen Morphologien der Aortenklappe werden differenziert beschrieben.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791PubMed Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791PubMed
2.
Zurück zum Zitat Mookadam F, Thota VR, Garcia-Lopez AM, Emani UR, Alharthi MS, Zamorano J, Khandheria BK (2010) Unicuspid aortic valve in adults: a systematic review. J Heart Valve Dis 19(1):79–85PubMed Mookadam F, Thota VR, Garcia-Lopez AM, Emani UR, Alharthi MS, Zamorano J, Khandheria BK (2010) Unicuspid aortic valve in adults: a systematic review. J Heart Valve Dis 19(1):79–85PubMed
4.
Zurück zum Zitat Nistri S, Sorbo MD, Marin M, Palisi M, Scognamiglio R, Thiene G (1999) Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 82(1):19–22PubMedPubMedCentral Nistri S, Sorbo MD, Marin M, Palisi M, Scognamiglio R, Thiene G (1999) Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 82(1):19–22PubMedPubMedCentral
5.
Zurück zum Zitat Nkomo VT, Enriquez-Sarano M, Ammash NM, Melton LJ 3rd, Bailey KR, Desjardins V, Horn RA, Tajik AJ (2003) Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol 23(2):351–356PubMed Nkomo VT, Enriquez-Sarano M, Ammash NM, Melton LJ 3rd, Bailey KR, Desjardins V, Horn RA, Tajik AJ (2003) Bicuspid aortic valve associated with aortic dilatation: a community-based study. Arterioscler Thromb Vasc Biol 23(2):351–356PubMed
6.
Zurück zum Zitat Roman MJ, Devereux RB, Niles NW, Hochreiter C, Kligfield P, Sato N, Spitzer MC, Borer JS (1987) Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Prevalence, clinical and echocardiographic patterns, and relation to left ventricular hypertrophy and function. Ann Intern Med 106(6):800–807PubMed Roman MJ, Devereux RB, Niles NW, Hochreiter C, Kligfield P, Sato N, Spitzer MC, Borer JS (1987) Aortic root dilatation as a cause of isolated, severe aortic regurgitation. Prevalence, clinical and echocardiographic patterns, and relation to left ventricular hypertrophy and function. Ann Intern Med 106(6):800–807PubMed
7.
Zurück zum Zitat Agozzino L, de Vivo F, Falco A et al (1994) Non-inflammatory aortic root disease and floppy aortic valve as cause of isolated regurgitation: a clinicomorphologic study. Int J Cardiol 45:129–134PubMed Agozzino L, de Vivo F, Falco A et al (1994) Non-inflammatory aortic root disease and floppy aortic valve as cause of isolated regurgitation: a clinicomorphologic study. Int J Cardiol 45:129–134PubMed
8.
Zurück zum Zitat Kaplan J, Farb A, Carliner NH, Virmani R (1991) Large aortic valve fenestrations producing chronic aortic regurgitation. Am Heart J 122(5):1475–1477PubMed Kaplan J, Farb A, Carliner NH, Virmani R (1991) Large aortic valve fenestrations producing chronic aortic regurgitation. Am Heart J 122(5):1475–1477PubMed
9.
Zurück zum Zitat Schäfers HJ, Langer F, Glombitza P, Kunihara T, Fries R, Aicher D (2010) Aortic valve reconstruction in myxomatous degeneration of aortic valves: are fenestrations a risk factor for repair failure? J Thorac Cardiovasc Surg 139(3):660–664PubMed Schäfers HJ, Langer F, Glombitza P, Kunihara T, Fries R, Aicher D (2010) Aortic valve reconstruction in myxomatous degeneration of aortic valves: are fenestrations a risk factor for repair failure? J Thorac Cardiovasc Surg 139(3):660–664PubMed
10.
Zurück zum Zitat le Polain de Waroux JB, Pouleur AC, Goffinet C, Vancraeynest D, Van Dyck M, Robert A, Gerber BL, Pasquet A, El Khoury G, Vanoverschelde JL (2007) Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation 116(11 Suppl):I264–9PubMed le Polain de Waroux JB, Pouleur AC, Goffinet C, Vancraeynest D, Van Dyck M, Robert A, Gerber BL, Pasquet A, El Khoury G, Vanoverschelde JL (2007) Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation 116(11 Suppl):I264–9PubMed
11.
Zurück zum Zitat Bentall H, De Bono A (1968) A technique for complete replacement of the ascending aorta. Thorax 23(4):338–339PubMedPubMedCentral Bentall H, De Bono A (1968) A technique for complete replacement of the ascending aorta. Thorax 23(4):338–339PubMedPubMedCentral
12.
Zurück zum Zitat David TE (1998) Aortic valve replacement with stentless porcine bioprostheses. J Card Surg 13(5):344–351PubMed David TE (1998) Aortic valve replacement with stentless porcine bioprostheses. J Card Surg 13(5):344–351PubMed
13.
Zurück zum Zitat Ross DN (1967) Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 2(7523):956–958PubMed Ross DN (1967) Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 2(7523):956–958PubMed
14.
Zurück zum Zitat David TE, Woo A, Armstrong S, Maganti M (2010) When is the Ross operation a good option to treat aortic valve disease? J Thorac Cardiovasc Surg 139(1):68–73 (discussion 73–75)PubMed David TE, Woo A, Armstrong S, Maganti M (2010) When is the Ross operation a good option to treat aortic valve disease? J Thorac Cardiovasc Surg 139(1):68–73 (discussion 73–75)PubMed
15.
Zurück zum Zitat Cannegieter SC, Rosendaal FR, Briët E (1994) Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89(2):635–641PubMed Cannegieter SC, Rosendaal FR, Briët E (1994) Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses. Circulation 89(2):635–641PubMed
16.
Zurück zum Zitat Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH (2000) Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 36(4):1152–1158PubMed Hammermeister K, Sethi GK, Henderson WG, Grover FL, Oprian C, Rahimtoola SH (2000) Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial. J Am Coll Cardiol 36(4):1152–1158PubMed
17.
Zurück zum Zitat Bouhout I, Stevens LM, Mazine A, Poirier N, Cartier R, Demers P, El-Hamamsy I (2014) Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg 148(4):1341–1346.e1PubMed Bouhout I, Stevens LM, Mazine A, Poirier N, Cartier R, Demers P, El-Hamamsy I (2014) Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg 148(4):1341–1346.e1PubMed
18.
Zurück zum Zitat Kvidal P, Bergström R, Hörte LG, Ståhle E (2000) Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 35(3):747–756PubMed Kvidal P, Bergström R, Hörte LG, Ståhle E (2000) Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 35(3):747–756PubMed
19.
Zurück zum Zitat Taylor WJ, Thrower WB, Black H, Harken DE (1958) The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg 35(2):192–205PubMed Taylor WJ, Thrower WB, Black H, Harken DE (1958) The surgical correction of aortic insufficiency by circumclusion. J Thorac Surg 35(2):192–205PubMed
20.
Zurück zum Zitat Cabrol C, Cabrol A, Guiraudon G, Bertrand M (1966) Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss 59(9):1305–1312PubMed Cabrol C, Cabrol A, Guiraudon G, Bertrand M (1966) Treatment of aortic insufficiency by means of aortic annuloplasty. Arch Mal Coeur Vaiss 59(9):1305–1312PubMed
21.
Zurück zum Zitat Durán CM, Alonso J, Gaite L, Alonso C, Cagigas JC, Marce L, Fleitas MG, Revuelta JM (1988) Long-term results of conservative repair of rheumatic aortic valve insufficiency. Eur J Cardiothorac Surg 2(4):217–223PubMed Durán CM, Alonso J, Gaite L, Alonso C, Cagigas JC, Marce L, Fleitas MG, Revuelta JM (1988) Long-term results of conservative repair of rheumatic aortic valve insufficiency. Eur J Cardiothorac Surg 2(4):217–223PubMed
22.
Zurück zum Zitat Cosgrove DM, Rosenkranz ER, Hendren WG, Bartlett JC, Stewart WJ (1991) Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg 102(4):571–576 (discussion 576–577)PubMed Cosgrove DM, Rosenkranz ER, Hendren WG, Bartlett JC, Stewart WJ (1991) Valvuloplasty for aortic insufficiency. J Thorac Cardiovasc Surg 102(4):571–576 (discussion 576–577)PubMed
23.
Zurück zum Zitat Frater RW (1986) Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation 74(3 Pt 2):I136–42PubMed Frater RW (1986) Aortic valve insufficiency due to aortic dilatation: correction by sinus rim adjustment. Circulation 74(3 Pt 2):I136–42PubMed
24.
Zurück zum Zitat Sarsam MA, Yacoub M (1993) Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg 105:435–438PubMed Sarsam MA, Yacoub M (1993) Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg 105:435–438PubMed
25.
Zurück zum Zitat David TE, Feindel CF (1992) An aortic valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 103:617–622PubMed David TE, Feindel CF (1992) An aortic valve sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 103:617–622PubMed
26.
Zurück zum Zitat Langer F, Aicher D, Kissinger A, Wendler O, Lausberg H, Fries R, Schäfers HJ (2004) Aortic valve repair using a differentiated surgical strategy. Circulation 110(11 Suppl 1):II67–73PubMed Langer F, Aicher D, Kissinger A, Wendler O, Lausberg H, Fries R, Schäfers HJ (2004) Aortic valve repair using a differentiated surgical strategy. Circulation 110(11 Suppl 1):II67–73PubMed
27.
Zurück zum Zitat Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, Verhelst R, Noirhomme P, El Khoury G (2009) Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg 137(2):286–294PubMed Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, Verhelst R, Noirhomme P, El Khoury G (2009) Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg 137(2):286–294PubMed
28.
Zurück zum Zitat Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ (2011) Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation 123(2):178–185PubMed Aicher D, Kunihara T, Abou Issa O, Brittner B, Gräber S, Schäfers HJ (2011) Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation 123(2):178–185PubMed
29.
Zurück zum Zitat Schäfers HJ, Bierbach B, Aicher D (2006) A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg 132(2):436–438PubMed Schäfers HJ, Bierbach B, Aicher D (2006) A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg 132(2):436–438PubMed
30.
Zurück zum Zitat Bierbach BO, Aicher D, Issa OA, Bomberg H, Gräber S, Glombitza P, Schäfers HJ (2010) Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg 38(4):400–406PubMed Bierbach BO, Aicher D, Issa OA, Bomberg H, Gräber S, Glombitza P, Schäfers HJ (2010) Aortic root and cusp configuration determine aortic valve function. Eur J Cardiothorac Surg 38(4):400–406PubMed
31.
Zurück zum Zitat le Polain de Waroux JB, Pouleur AC, Robert A, Pasquet A, Gerber BL, Noirhomme P, El Khoury G, Vanoverschelde JL (2009) Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging 2(8):931–939PubMed le Polain de Waroux JB, Pouleur AC, Robert A, Pasquet A, Gerber BL, Noirhomme P, El Khoury G, Vanoverschelde JL (2009) Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging 2(8):931–939PubMed
32.
Zurück zum Zitat Lansac E, Di Centa I, Sleilaty G, Lejeune S, Berrebi A, Zacek P, Debauchez M (2017) Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg 153(5):1033–1042PubMed Lansac E, Di Centa I, Sleilaty G, Lejeune S, Berrebi A, Zacek P, Debauchez M (2017) Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg 153(5):1033–1042PubMed
33.
Zurück zum Zitat de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengelé B, Gianello P, Mosala Nezhad Z, Astarci P, Noirhomme P, El Khoury G (2015) Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg 149(2):425–433PubMed de Kerchove L, Jashari R, Boodhwani M, Duy KT, Lengelé B, Gianello P, Mosala Nezhad Z, Astarci P, Noirhomme P, El Khoury G (2015) Surgical anatomy of the aortic root: implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg 149(2):425–433PubMed
34.
Zurück zum Zitat Schäfers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, Aicher D (2015) Reexamining remodeling. J Thorac Cardiovasc Surg 149(2 Suppl):S30–S36PubMed Schäfers HJ, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, Aicher D (2015) Reexamining remodeling. J Thorac Cardiovasc Surg 149(2 Suppl):S30–S36PubMed
35.
Zurück zum Zitat Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ (2017) Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg 103(2):504–510PubMed Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ (2017) Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg 103(2):504–510PubMed
36.
Zurück zum Zitat Schneider U, Feldner SK, Hofmann C, Schöpe J, Wagenpfeil S, Giebels C, Schäfers HJ (2017) Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg 153(4):S65–S71PubMed Schneider U, Feldner SK, Hofmann C, Schöpe J, Wagenpfeil S, Giebels C, Schäfers HJ (2017) Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg 153(4):S65–S71PubMed
37.
Zurück zum Zitat Miyahara S, Schneider U, Morgenthaler L, Schäfers HJ (2019) (Almost) All nonstenotic bicuspid aortic valves should be preserved or repaired. Semin Thorac Cardiovasc Surg 31:656–660PubMed Miyahara S, Schneider U, Morgenthaler L, Schäfers HJ (2019) (Almost) All nonstenotic bicuspid aortic valves should be preserved or repaired. Semin Thorac Cardiovasc Surg 31:656–660PubMed
39.
Zurück zum Zitat Sabet HY, Edwards WD, Tazelaar HD, Daly RC (1999) Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2,715 additional cases. Mayo Clin Proc 74(1):14–26PubMed Sabet HY, Edwards WD, Tazelaar HD, Daly RC (1999) Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2,715 additional cases. Mayo Clin Proc 74(1):14–26PubMed
40.
Zurück zum Zitat Schmidt KI, Jeserich M, Aicher D, Schäfers HJ (2008) Tricuspidization of the quadricuspid aortic valve. Ann Thorac Surg 85(3):1087–1089PubMed Schmidt KI, Jeserich M, Aicher D, Schäfers HJ (2008) Tricuspidization of the quadricuspid aortic valve. Ann Thorac Surg 85(3):1087–1089PubMed
41.
Zurück zum Zitat De Kerchove L, Momeni M, Aphram G, Watremez C, Bollen X, Jashari R, Boodhwani M, Astarci P, Noirhomme P, El Khoury G (2018) Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study. Eur J Cardiothorac Surg 53(5):1040–1048PubMed De Kerchove L, Momeni M, Aphram G, Watremez C, Bollen X, Jashari R, Boodhwani M, Astarci P, Noirhomme P, El Khoury G (2018) Free margin length and coaptation surface area in normal tricuspid aortic valve: an anatomical study. Eur J Cardiothorac Surg 53(5):1040–1048PubMed
42.
Zurück zum Zitat Schäfers HJ, Schmied W, Marom G, Aicher D (2013) Cusp height in aortic valves. J Thorac Cardiovasc Surg 146(2):269–274PubMed Schäfers HJ, Schmied W, Marom G, Aicher D (2013) Cusp height in aortic valves. J Thorac Cardiovasc Surg 146(2):269–274PubMed
43.
Zurück zum Zitat Khelil N, Sleilaty G, Palladino M, Fouda M, Escande R, Debauchez M, Di Centa I, Lansac E (2015) Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg 99(4):1220–1226PubMed Khelil N, Sleilaty G, Palladino M, Fouda M, Escande R, Debauchez M, Di Centa I, Lansac E (2015) Surgical anatomy of the aortic annulus: landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg 99(4):1220–1226PubMed
44.
Zurück zum Zitat de Kerchove L, Mastrobuoni S, Froede L, Tamer S, Boodhwani M, van Dyck M, El Khoury G, Schäfers HJ (2019) Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg 56:351–359 de Kerchove L, Mastrobuoni S, Froede L, Tamer S, Boodhwani M, van Dyck M, El Khoury G, Schäfers HJ (2019) Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification. Eur J Cardiothorac Surg 56:351–359
45.
Zurück zum Zitat Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ (2012) Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg 42(6):1010–1015PubMed Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ (2012) Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg 42(6):1010–1015PubMed
46.
Zurück zum Zitat Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E (2013) Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg 146(5):1227–1231PubMed Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E (2013) Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg 146(5):1227–1231PubMed
47.
Zurück zum Zitat Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E (2013) Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair. J Thorac Cardiovasc Surg 145(2):406–411.e1PubMed Marom G, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E (2013) Aortic root numeric model: annulus diameter prediction of effective height and coaptation in post-aortic valve repair. J Thorac Cardiovasc Surg 145(2):406–411.e1PubMed
48.
Zurück zum Zitat Ouzounian M, Rao V, Manlhiot C, Abraham N, David C, Feindel CM, David TE (2016) Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilation. J Am Coll Cardiol 68(17):1838–1847PubMed Ouzounian M, Rao V, Manlhiot C, Abraham N, David C, Feindel CM, David TE (2016) Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilation. J Am Coll Cardiol 68(17):1838–1847PubMed
49.
Zurück zum Zitat Aicher D, Fries R, Rodionycheva S, Schmidt K, Langer F, Schäfers HJ (2010) Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg 37(1):127–132PubMed Aicher D, Fries R, Rodionycheva S, Schmidt K, Langer F, Schäfers HJ (2010) Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg 37(1):127–132PubMed
50.
Zurück zum Zitat de Meester C, Pasquet A, Gerber BL, Vancraeynest D, Noirhomme P, El Khoury G, Vanoverschelde JL (2014) Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg 148(5):1913–1920PubMed de Meester C, Pasquet A, Gerber BL, Vancraeynest D, Noirhomme P, El Khoury G, Vanoverschelde JL (2014) Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg 148(5):1913–1920PubMed
51.
Zurück zum Zitat Schäfers HJ, Aicher D, Riodionycheva S, Lindinger A, Rädle-Hurst T, Langer F, Abdul-Khaliq H (2008) Bicuspidization of the unicuspid aortic valve: a new reconstructive approach. Ann Thorac Surg 85(6):2012–2018PubMed Schäfers HJ, Aicher D, Riodionycheva S, Lindinger A, Rädle-Hurst T, Langer F, Abdul-Khaliq H (2008) Bicuspidization of the unicuspid aortic valve: a new reconstructive approach. Ann Thorac Surg 85(6):2012–2018PubMed
52.
Zurück zum Zitat Schneider U, Ehrlich T, Karliova I, Giebels C, Schäfers HJ (2017) Valve-sparing aortic root replacement in patients with Marfan syndrome-the Homburg experience. Ann Cardiothorac Surg 6(6):697–703PubMedPubMedCentral Schneider U, Ehrlich T, Karliova I, Giebels C, Schäfers HJ (2017) Valve-sparing aortic root replacement in patients with Marfan syndrome-the Homburg experience. Ann Cardiothorac Surg 6(6):697–703PubMedPubMedCentral
53.
Zurück zum Zitat Franciulli M, Aicher D, Rädle-Hurst T, Takahashi H, Rodionycheva S, Schäfers HJ (2014) Root remodeling and aortic valve repair for unicuspid aortic valve. Ann Thorac Surg 98(3):823–829PubMed Franciulli M, Aicher D, Rädle-Hurst T, Takahashi H, Rodionycheva S, Schäfers HJ (2014) Root remodeling and aortic valve repair for unicuspid aortic valve. Ann Thorac Surg 98(3):823–829PubMed
54.
Zurück zum Zitat Matsushima S, Igarashi T, Shimizu A, Ehrlich T, Karliova I, Schäfers HJ (2019) Symmetric bicuspidization and annuloplasty provide a functioning valve configuration to unicuspid aortic valve. Struct Heart 3(sup1):14 Matsushima S, Igarashi T, Shimizu A, Ehrlich T, Karliova I, Schäfers HJ (2019) Symmetric bicuspidization and annuloplasty provide a functioning valve configuration to unicuspid aortic valve. Struct Heart 3(sup1):14
55.
Zurück zum Zitat Mayer K, Aicher D, Feldner S, Kunihara T, Schäfers HJ (2012) Repair versus replacement of the aortic valve in active infective endocarditis. Eur J Cardiothorac Surg 42(1):122–127PubMed Mayer K, Aicher D, Feldner S, Kunihara T, Schäfers HJ (2012) Repair versus replacement of the aortic valve in active infective endocarditis. Eur J Cardiothorac Surg 42(1):122–127PubMed
56.
Zurück zum Zitat Karliova I, Schneider U, Ehrlich T, Schäfers HJ (2019) Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg 109:728–735PubMed Karliova I, Schneider U, Ehrlich T, Schäfers HJ (2019) Results of pericardial patches in tricuspid and bicuspid aortic cusp repair. Ann Thorac Surg 109:728–735PubMed
57.
Zurück zum Zitat Schneider U, Aicher D, Miura Y, Schäfers HJ (2016) Suture annuloplasty in aortic valve repair. Ann Thorac Surg 101(2):783–785PubMed Schneider U, Aicher D, Miura Y, Schäfers HJ (2016) Suture annuloplasty in aortic valve repair. Ann Thorac Surg 101(2):783–785PubMed
58.
Zurück zum Zitat Lansac E, Di Centa I, Varnous S, Rama A, Jault F, Duran CM, Acar C, Pavie A, Gandjbakhch I (2005) External aortic annuloplasty ring for valve-sparing procedures. Ann Thorac Surg 79(1):356–358PubMed Lansac E, Di Centa I, Varnous S, Rama A, Jault F, Duran CM, Acar C, Pavie A, Gandjbakhch I (2005) External aortic annuloplasty ring for valve-sparing procedures. Ann Thorac Surg 79(1):356–358PubMed
59.
Zurück zum Zitat Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, Pirk J, Detter C, Kroll J, Beyersdorf F, Griffin CD, Shrestha M, Nöbauer C, Crooke PS, Schreiber C, Lange R (2016) Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg 49(3):987–993PubMed Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, Pirk J, Detter C, Kroll J, Beyersdorf F, Griffin CD, Shrestha M, Nöbauer C, Crooke PS, Schreiber C, Lange R (2016) Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg 49(3):987–993PubMed
60.
Zurück zum Zitat Schäfers HJ, Aicher D, Langer F, Lausberg HF (2007) Preservation of the bicuspid aortic valve. Ann Thorac Surg 83(2):S740–S745 (discussion S785–790)PubMed Schäfers HJ, Aicher D, Langer F, Lausberg HF (2007) Preservation of the bicuspid aortic valve. Ann Thorac Surg 83(2):S740–S745 (discussion S785–790)PubMed
61.
Zurück zum Zitat de Kerchove L, Boodhwani M, Glineur D, Noirhomme P, El Khoury G (2011) A new simple and objective method for graft sizing in valve-sparing root replacement using the reimplantation technique. Ann Thorac Surg 92(2):749–751PubMed de Kerchove L, Boodhwani M, Glineur D, Noirhomme P, El Khoury G (2011) A new simple and objective method for graft sizing in valve-sparing root replacement using the reimplantation technique. Ann Thorac Surg 92(2):749–751PubMed
62.
Zurück zum Zitat Casselman FP, Gillinov AM, Akhrass R, Kasirajan V, Blackstone EH, Cosgrove DM (1999) Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg 15(3):302–308PubMed Casselman FP, Gillinov AM, Akhrass R, Kasirajan V, Blackstone EH, Cosgrove DM (1999) Intermediate-term durability of bicuspid aortic valve repair for prolapsing leaflet. Eur J Cardiothorac Surg 15(3):302–308PubMed
63.
Zurück zum Zitat Schneider U, Schmied W, Aicher D, Giebels C, Winter L, Schäfers HJ (2017) Sinus plication to improve valve configuration in bicuspid aortic valve repair-early results. Ann Thorac Surg 103(2):580–585PubMed Schneider U, Schmied W, Aicher D, Giebels C, Winter L, Schäfers HJ (2017) Sinus plication to improve valve configuration in bicuspid aortic valve repair-early results. Ann Thorac Surg 103(2):580–585PubMed
64.
Zurück zum Zitat Aicher D, Bewarder M, Kindermann M, Abdul-Khalique H, Schäfers HJ (2013) Aortic valve function after bicuspidization of the unicuspid aortic valve. Ann Thorac Surg 95(5):1545–1550PubMed Aicher D, Bewarder M, Kindermann M, Abdul-Khalique H, Schäfers HJ (2013) Aortic valve function after bicuspidization of the unicuspid aortic valve. Ann Thorac Surg 95(5):1545–1550PubMed
65.
Zurück zum Zitat David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T (2015) Outcomes of aortic valve-sparing operations in marfan syndrome. J Am Coll Cardiol 66(13):1445–1453PubMed David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T (2015) Outcomes of aortic valve-sparing operations in marfan syndrome. J Am Coll Cardiol 66(13):1445–1453PubMed
66.
Zurück zum Zitat Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ (2018) Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg 155(3):885–894.e3PubMed Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ (2018) Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg 155(3):885–894.e3PubMed
67.
Zurück zum Zitat David TE, David CM, Feindel CM, Manlhiot C (2017) Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg 153(2):232–238PubMed David TE, David CM, Feindel CM, Manlhiot C (2017) Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg 153(2):232–238PubMed
68.
Zurück zum Zitat de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, El Khoury G (2011) Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg 142(6):1430–1438PubMed de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde JL, Noirhomme P, El Khoury G (2011) Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg 142(6):1430–1438PubMed
69.
Zurück zum Zitat Fries R, Graeter T, Aicher D, Reul H, Schmitz C, Böhm M, Schäfers HJ (2006) In vitro comparison of aortic valve movement after valve-preserving aortic replacement. J Thorac Cardiovasc Surg 132(1):32–37PubMed Fries R, Graeter T, Aicher D, Reul H, Schmitz C, Böhm M, Schäfers HJ (2006) In vitro comparison of aortic valve movement after valve-preserving aortic replacement. J Thorac Cardiovasc Surg 132(1):32–37PubMed
70.
Zurück zum Zitat Nawaytou O, Mastrobuoni S, de Kerchove L, Baert J, Boodhwani M, El Khoury G (2018) Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus. J Thorac Cardiovasc Surg 156(2):590–597PubMed Nawaytou O, Mastrobuoni S, de Kerchove L, Baert J, Boodhwani M, El Khoury G (2018) Deep circumferential annuloplasty as an adjunct to repair regurgitant bicuspid aortic valves with a dilated annulus. J Thorac Cardiovasc Surg 156(2):590–597PubMed
Metadaten
Titel
Aortenklappenrekonstruktion
Von Improvisation zur Standardisierung
verfasst von
Dr. med. U. Schneider
Univ.-Prof. Dr. med. H.-J. Schäfers
Publikationsdatum
02.09.2020
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie / Ausgabe 5/2020
Print ISSN: 0930-9225
Elektronische ISSN: 1435-1277
DOI
https://doi.org/10.1007/s00398-020-00390-2

Weitere Artikel der Ausgabe 5/2020

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 5/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.