Zeitschrift für Kardiologie

, Volume 90, Supplement 6, pp 48–57 | Cite as

Patientenadaptierte Klappenselektion: biologischer vs. mechanischer Herzklappenersatz bei Aortenklappenvitien

  • Stefan Brose
  • Rüdiger Autschbach
  • Mark Engel
  • Thomas Rauch
  • Friedrich Wilhelm Rauch
Article
First Online:

Zusammenfassung

Die operative Versorgung von Aortenklappenvitien durch Ersatz der nativen Klappe mit einer Herzklappenprothese hat sich seit der ersten Operation im Jahre 1960 durch Harken zu einer der am häufigsten durchgeführten Eingriffe in der Herzchirurgie entwickelt. Für den Klappenersatz stehen biologische (Xenografts und Homografts) und mechanische Herzklappenprothesen zur Verfügung. Bei der Auswahl der geeigneten Prothese muss zwischen der eingeschränkten Haltbarkeit einer Bioprothese und dem Risiko der lebenslangen Antikoagulation bei einer mechanischen Prothese abgewogen werden.

In dem vorliegenden Artikel wird zunächst die Operationsindikation bei Aortenklappenstenose und Aortenklappeninsuffizienz diskutiert.

Anhand von Ergebnissen aus der Literatur der letzten 2 Jahre werden die Vor- und Nachteile der mechanischen und biologischen Herzklappenprothesen (Xenograft, Homograft und ROSS-Operation) erörtert. Zusätzlich werden seltener eingesetzte Verfahren wie die Aortenklappenrekonstruktion beleuchtet.

Bei der Haltbarkeit biologischer Herzklappenprothesen von etwa 12–15 Jahren und einem steigenden Risiko für Blutungskomplikationen unter Antikoagulation mit zunehplötzlimendem Lebensalter ist die Wahl einer Bioprothese etwa ab dem 65. Lebensjahr empfehlenswert. Ob diese Grenze durch den Einsatz gerüstfreier Bioprothesen herabgesetzt werden kann, bleibt abzuwarten, bis Ergebnisse von Langzeitstudien dieser Klappen vorliegen.

Schlüsselwörter

Aortenklappenstenose Aortenklappeninsuffizienz Mechanische Herzklappenprothese Biologische Herzklappenprothese Review 

Patient adapted valve selection: biological vs. mechanical heart valve replacement in aortic valve diseases

Summary

Since the first aortic valve replacement performed by Harken in 1960, the operation of aortic valve disease by replacing the native valve with a heart valve prosthesis has become one of the most frequently performed procedures in cardiac surgery. For valve replacement there are biological (xenografts and homografts) and mechanical heart valve prostheses available. When choosing the most suitable prosthesis the limited durability of a biological prosthesis and the risks of lifelong anticoagulation for a mechanical prosthesis have to be balanced.

In this article the indication for operation of aortic valve stenosis and aortic regurgitation are discussed first. Based on the literature of the last 2 years the advantages and disadvantages of mechanical and biological heart valve prostheses (xenograft, homograft and ROSS procedure) are discussed. In addition rarely used techniques like aortic valve reconstruction are presented.

Due to the fact that a biological prosthesis has a durability of 12–15 years and the risk of bleeding complications under anticoagulation grows with increasing age, the choice of a biological prosthesis can be recommended from the age of 65 years. Results of long-term studies at to whether this limit can be diminished by using a stentless biological prosthesis have to be awaited.

Key words

Aortic valve stenosis aortic valve insufficiency mechanical heart valve prosthesis biological heart valve prosthesis review 
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Copyright information

© Steinkopff Verlag 2001

Authors and Affiliations

  • Stefan Brose
    • 1
  • Rüdiger Autschbach
    • 1
  • Mark Engel
    • 1
  • Thomas Rauch
    • 2
  • Friedrich Wilhelm Rauch
    • 2
  1. 1.Klinik für Thorax-, Herz- und GefäßchirurgieKlinikum RWTH AachenAachenGermany
  2. 2.Herzzentrum LeipzigKlinik für HerzchirurgieLeipzigGermany

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