Elektive Koronarrevaskularisation

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Übersicht
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Zusammenfassung

Die koronare Revaskularisation ist nach wie vor der häufigste Eingriff in der Herzchirurgie. Obwohl das Prinzip stets identisch ist, wird das Operationsziel mit unterschiedlichen Grafts und Techniken erreicht. Schwerpunkte der Übersicht sind die Verwendung der extrakorporalen Zirkulation, Graftwahl und -gewinnung sowie spezielle Anastomosierungstechniken. Genau betrachtet ist jeder Schritt der Koronarrevaskularisation Gegenstand aktueller Untersuchungen. Die Literaturauswahl kann bei dieser Thematik keine Vollständigkeit beanspruchen und dient vielmehr als grober Überblick. Standard ist heute für die Behandlung der Mehrgefäßerkrankung die Verwendung mindestens einer A. thoracica interna in Kombination mit venösen oder anderen arteriellen Grafts. Die zunehmende Zahl von Patienten mit erheblicher Komorbidität und/oder diffuser koronarer Herzerkrankung erfordert spezielle Überlegungen und Techniken. Gerade das sich verändernde Risikoprofil der Patienten stellt hohe Ansprüche an das intraoperative Management. Darüber hinaus ist jedoch die postoperative Weiterbehandlung für die Sicherung des Operationserfolgs entscheidend.

Schlüsselwörter

aortokoronare Bypassoperation Revaskularisation Technik Bypassmaterial Anastomosierung 

Elective coronary revascularization. What is evidence-based?

Abstract

Coronary artery bypass grafting still represents the main procedure in cardiac surgery. Although the surgical principle remains identical, the surgical goal can be achieved by numerous grafts and techniques. The main topics of this survey are the use of extracorporeal circulation, choice and harvesting of the grafts and special surgical techniques. Specifically, each surgical step is considered part of a scientific investigation. The current references cannot be considered complete, but serve as a rough survey of the literature. The current standard procedure for coronary multivessel disease consists of at least one internal mammary artery combined with venous or other arterial grafts. The increasing number of patients with significant comorbidity and/or diffuse type of coronary artery disease requires special consideration and techniques. Even the further increasing risk profile of the patients demands optimal intraoperative management. In addition, postoperative management is decisive for the surgical success.

Keywords

coronary artery bypass grafting (CABG) surgical revascularization technique graft material anastomosis 

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Copyright information

© Steinkopff-Verlag 2008

Authors and Affiliations

  1. 1.Westdeutsches Herzzentrum Universität EssenBRD
  2. 2.Westdeutsches HerzzentrumKlinik für Thorax- und Kardiovaskuläre Chirurgie, Universität EssenEssen

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