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Chirurgische Therapie der Mitralinsuffizienz

Wann, wen, wie?

Surgical therapy of mitral regurgitation

When, whom, how?

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Zusammenfassung

Die chirurgische Therapie der Mitralinsuffizienz (MI) unterliegt einem bedeutsamen Wandel. Galt lange Zeit der prothetische Mitralklappenersatz als Therapie der Wahl, so wissen wir heute, dass die Mitralrekonstruktion (MKR) immer dann vorzuziehen ist, wenn die technische Möglichkeit zum Erhalt der Klappe besteht. In Deutschland trifft dies auf mehr als 80% der bedeutsamen Mitralvitien zu, was an entsprechenden Rekonstruktionsraten in erfahrenen Zentren abzulesen ist. Dabei wird die Indikation für die Operation heute bereits beim asymptomatischen Patienten mit hochgradiger Mitralklappeninsuffizienz gestellt, vorausgesetzt die Rekonstruktionswahrscheinlichkeit ist hoch und das operative Risiko niedrig. Minimal-invasive Mitralrekonstruktionen haben nochmals zu einer deutlichen Reduktion der operativen Invasivität geführt und gehen mit niedrigen Komplikationsraten und exzellenten Ergebnissen einher. Die Mortalität nach isolierter Mitralklappenchirurgie kann so in erfahrenen Zentren bis zu 0% betragen. Wird die Rekonstruktion zum richtigen Zeitpunkt vorgenommen, so erreicht die postoperative Lebenserwartung das Niveau einer altersentsprechenden nicht erkrankten Vergleichspopulation.

Abstract

Surgical therapy for mitral valve regurgitation is undergoing significant change. For decades mitral valve replacement was the first choice therapy; now we know that mitral reconstruction has to be performed whenever it is technically possible. Numbers from experienced centers imply that in more than 80% of patients with significant mitral valve disease reconstruction is feasible. Today even asymptomatic patients fulfill the indication for mitral valve surgery once mitral reconstruction can be performed and surgical risk is low. Minimally invasive mitral valve reconstructions have furthermore lowered operative invasiveness and go along with low complication rates and excellent results. Mortality after isolated mitral valve surgery can be as low as 0% in experienced centers. Life expectancy of patients after mitral valve reconstruction is at the level of the average population at the same age if the right time point for the operation is chosen.

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

    H. Treede, L. Conradi & H. Reichenspurner

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  1. H. Treede
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  2. L. Conradi
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  3. H. Reichenspurner
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Correspondence to H. Treede.

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Treede, H., Conradi, L. & Reichenspurner, H. Chirurgische Therapie der Mitralinsuffizienz. Kardiologe 4, 163–172 (2010). https://doi.org/10.1007/s12181-009-0250-x

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  • DOI: https://doi.org/10.1007/s12181-009-0250-x

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