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Literaturübersicht 2018 zur Herzklappenchirurgie

Literature review 2018 on heart valve surgery

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Wie im letzten Jahr wird eine Übersicht über interessante und relevante Literatur aus dem Bereich der Klappenchirurgie – im vorliegenden Beitrag für das Jahr 2018 – präsentiert. Therapieentscheidungen bei Vorliegen einer relevanten Aortenklappenerkrankung sind geprägt von Empfehlungen aus individuellen Entscheidungen im Herzteam, mit immer stärker werdender Evidenz für die „transcatheter aortic valve implantation“ (TAVI) bei niedrigem Risiko, ohne dass bisher zwingend benötigte Langzeitergebnisse vorliegen. Es wird in diesem Abschnitt nur auf die TAVI-Publikationen eingegangen, die unmittelbare Relevanz für die klassischen chirurgischen Verfahren aufweisen, die ansonsten im vorliegenden Beitrag hauptsächlich beleuchtet werden. Die Publikationen im Bereich der Atrioventrikularklappen lieferten neue Erkenntnisse zur Prävalenz von Mitral- und Trikuspidalinsuffizienz und unterstrichen damit die bekannten Aussagen, dass eine Mitralklappenrekonstruktion bei struktureller Mitralinsuffizienz die Lebenserwartung steigern kann. Bei funktioneller Mitralinsuffizienz hat v. a. die Publikation der Studien MITRA FR und COAPT im Zusammenhang mit dem MitraClip große Aufmerksamkeit erregt. Außerdem unterstützen weitere Studienergebnisse die aggressive Therapie der isolierten Trikuspidalinsuffizienz. Diese Aspekte werden im Folgenden erläutert, obwohl Übersichten wie diese nie komplett oder frei von persönlicher Neigung sein und nie alle potenziell relevanten Arbeiten berücksichtigen können. Unter diesem Caveat wünschen die Autoren Freude beim Lesen.

Abstract

As in last year, an overview of interesting and relevant literature in the field of valve surgery published in 2018 is presented. Treatment decisions in the presence of relevant aortic valve diseases are influenced by recommendations from individual decisions by the heart team. There is growing evidence for transcatheter aortic valve implantation (TAVI) with a lower risk but long-term results are still lacking. This article only addresses TAVI publications that are of direct relevance for classical surgical procedures, which are otherwise mainly elucidated here. The publications in the field of atrioventricular valves provided new knowledge on the prevalence of mitral and tricuspid valve regurgitation and therefore underline renewed support for the statement that mitral valve reconstruction for structural mitral valve regurgitation can increase life expectancy. In functional mitral valve regurgitation, particularly the MITRA FR and COAPT studies in association with the MitraClip have aroused great attention. In addition, more support for aggressive treatment of isolated tricuspid valve regurgitation has appeared. These aspects are elucidated in this article although reviews such as this are never complete or free from personal bias and can never consider all potentially relevant articles. Given this caveat the authors hope the information will be useful and interesting.

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Authors and Affiliations

  1. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland

    A. Moschovas, R. Safarov, T. Sandhaus, S. Tkebuchava, C. Schenkl, H. Kirov, G. Färber & T. Doenst

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  1. A. Moschovas
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  2. R. Safarov
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  3. T. Sandhaus
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  4. S. Tkebuchava
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  6. H. Kirov
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Correspondence to A. Moschovas.

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Interessenkonflikt

A. Moschovas, R. Safarov, T. Sandhaus, S. Tkebuchava, C. Schenkl, H. Kirov, G. Färber und T. Doenst geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Moschovas, A., Safarov, R., Sandhaus, T. et al. Literaturübersicht 2018 zur Herzklappenchirurgie. Z Herz- Thorax- Gefäßchir 33, 434–445 (2019). https://doi.org/10.1007/s00398-019-00332-7

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  • DOI: https://doi.org/10.1007/s00398-019-00332-7

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