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Therapie der Mitralklappeninsuffizienz

Chirurgische und interventionelle Neuerungen

Treating mitral regurgitation

A surgical and interventional update

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Zusammenfassung

In der Therapie der Mitralklappeninsuffizienz (MI) hat sich die rekonstruktive Klappenchirurgie zum Goldstandard entwickelt. Diese ist dem prothetischen Klappenersatz hinsichtlich der perioperativen Komplikationsraten und der Langzeitergebnisse deutlich überlegen. Zudem setzt sich zunehmend ein minimal-invasives chirurgisches Vorgehen durch, welches das operative Trauma reduziert und dem konventionellen Eingriff im Ergebnis mindestens ebenbürtig ist. Allerdings bleibt die Operation einer wachsenden Zahl von Patienten verwehrt. Hierbei handelt es sich v. a. um ältere Patienten mit reduzierter Ventrikelfunktion und funktioneller MI, die häufig relevante Komorbiditäten aufweisen. Für diese Patienten können katheterbasierte Mitralklappentherapien eine gute Alternative zum chirurgischen Vorgehen darstellen. Die meisten der neuen interventionellen Techniken befinden sich in experimentellen oder frühen klinischen Entwicklungsstadien. Einzig mit dem MitraClip®-System, welches eine interventionelle Segelplastik ermöglicht, besteht inzwischen umfassende klinische Erfahrung. Für den Erfolg eines patientenorientierten Mitralklappenprogramms ist die Integration chirurgischer und interventioneller Verfahren an einem Herzzentrum maßgeblich. Die Bildung eines interdisziplinären sog. „Heart-Teams“, das sich aus Kardiologen und Herzchirurgen zusammensetzt, ist hierfür von entscheidender Bedeutung.

Abstract

Surgical mitral valve repair has constantly evolved to become the standard of care for severe mitral regurgitation (MR) with superior acute and long-term results compared to valve replacement. Minimally-invasive surgical techniques have been successful in reducing operative trauma while yielding equivalent or even superior results compared to the conventional sternotomy approach. However, due to elevated operative risk a growing proportion of patients are not referred for surgery, especially elderly patients with reduced ventricular function and functional MR who often present with relevant comorbidities. It is for these patients that transcatheter-based therapies may represent an attractive option. While most interventional techniques are still in experimental or early clinical stages of development, relevant clinical experience has been gained with the MitraClip® device. For successful implementation of a patient-centered mitral valve program, integration of surgical and interventional treatment modalities within a heart center is of paramount importance. This is best accomplished by an interdisciplinary dedicated heart team consisting of cardiologists and cardiac surgeons.

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Authors and Affiliations

  1. Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    L. Conradi, H. Treede, M. Seiffert &  H. Reichenspurner

  2. Universitäres Herzzentrum Hamburg, Klinik und Poliklinik für Allgemeine und Interventionelle Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    S. Baldus & S. Blankenberg

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  1. L. Conradi
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  2. H. Treede
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  3. S. Baldus
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  4. M. Seiffert
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  5. S. Blankenberg
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  6. H. Reichenspurner
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Correspondence to H. Reichenspurner.

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Conradi, L., Treede, H., Baldus, S. et al. Therapie der Mitralklappeninsuffizienz. Herz 36, 677–685 (2011). https://doi.org/10.1007/s00059-011-3531-7

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