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Erschienen in: Der Kardiologe 3/2018

28.05.2018 | Sternotomie | Übersichten

Minimal-invasive Aortenklappenrekonstruktion

Standardtherapie für junge Patienten mit Aortenklappeninsuffizienz?

verfasst von: Prof. Dr. E. Girdauskas, J. Petersen, C. Detter, J. Kubitz, C. Sinning, N. Schofer, S. Blankenberg, H. Reichenspurner

Erschienen in: Die Kardiologie | Ausgabe 3/2018

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Zusammenfassung

Hintergrund

Eine valvuläre Kardiomyopathie bei hochgradiger Aortenklappeninsuffizienz hat einen prognostisch ungünstigen Verlauf, und die Aortenklappenersatzverfahren sind im jüngeren Patientenkollektiv mit deutlichen Limitationen verbunden.

Fragestellung

Stellenwert der rekonstruktiven Operationsverfahren und minimal-invasiven Zugangswegen in der Behandlung der hochgradigen Aortenklappeninsuffizienz.

Material und Methode

Analyse der aktuellen Literatur zum heutigen Wissensstand in der Behandlung der relevanten Aortenklappeninsuffizienz und Darstellung der Erfahrung mit Aortenklappenrekonstruktionsmethoden.

Ergebnisse

Konventioneller Aortenklappenersatz mittels mechanischer bzw. biologischer Klappenprothese bietet keine langfristig gute Lösung im jungen Patientenkollektiv mit relevanter Aortenklappeninsuffizienz. Die Strategie der Verzögerung des Operationszeitpunktes bis in das fortgeschrittene Alter, in dem die Haltbarkeit der Bioprothesen signifikant besser ist, beinhaltet ein unkalkulierbares Risiko einer valvulären Kardiomyopathie, von der sich die meisten Patienten nicht mehr erholen. Die Methoden der Aortenklappenrekonstruktion sind in erfahrenen Herzzentren heutzutage gut etabliert und gehören zur klinischen Routine. Das perioperative Risiko in diesem relativ jungen Patientenkollektiv liegt unter 1 % und die 10- bis 15-Jahresergebnisse sind anhand der publizierten Daten sehr zufriedenstellend.

Schlussfolgerungen

Heutige rekonstruktive Operationsmethoden bei Aortenklappeninsuffizienz bieten eine sehr sinnvolle Therapiealternative und versprechen durch die optimal gestaltete Geometrie solcher Aortenklappen eine langfristige Lösung mit niedrigem Komplikationsrisiko und erhaltener Lebensqualität ohne orale Antikoagulation im jungen und aktiven Patientenkollektiv.
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Metadaten
Titel
Minimal-invasive Aortenklappenrekonstruktion
Standardtherapie für junge Patienten mit Aortenklappeninsuffizienz?
verfasst von
Prof. Dr. E. Girdauskas
J. Petersen
C. Detter
J. Kubitz
C. Sinning
N. Schofer
S. Blankenberg
H. Reichenspurner
Publikationsdatum
28.05.2018
Verlag
Springer Medizin
Erschienen in
Die Kardiologie / Ausgabe 3/2018
Print ISSN: 2731-7129
Elektronische ISSN: 2731-7137
DOI
https://doi.org/10.1007/s12181-018-0254-5

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