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Klappenchirurgie

Wie spät ist früh genug?

Heart valve surgery. How late is early enough?

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

Zusammenfassung

Leitlinien für die Behandlung von Patienten mit Klappenfehlern legen auch Operationsindikationen fest: aufgrund des Operationsrisikos möglichst spät, andererseits jedoch so früh, dass Herz und Organsysteme nicht irreversibel geschädigt sind. Da chirurgische Weiterentwicklungen das Risiko reduzieren, müssen die Empfehlungen stetig hinterfragt werden. Konsens besteht bei den Op-Indikationen symptomatischer Vitien. Dennoch wird im Falle der Aortenklappenstenose die Operation, die minimalinvasiv besonders risikoarm erfolgen kann, vielen Patienten vorenthalten. In der Diskussion ist die Behandlung asymptomatischer Fälle. Die leitliniengerechte Anwendung von Belastungstests wird zu selten genutzt. Für die asymptomatische Aortenklappenstenose mehren sich die Hinweise, dass ein Teil der Patienten von einer frühzeitigen Operation profitiert, wobei die Identifizierung eben dieser Patienten schwierig bleibt. Fortschritte bei der Rekonstruktion undichter Mitral- oder Aortenklappen haben zumindest für die Mitralklappe klar dazu geführt, dass eine Operationsindikation früher gestellt wird; für die Aortenklappe deutet sich eine ähnliche Einschätzung an. Die chirurgische Expertise entwickelt sich zu einem wichtigen Kriterium für eine Operationsentscheidung.

Abstract

Indications for surgery form part of the guidelines for the treatment of valvular heart disease. The goal is to avoid risk associated with surgery as long as possible without reaching the point of irreversible damage to the heart and other organs. Since improvements of surgical techniques have reduced the operative risk these guidelines need revision periodically. Treatment of symptomatic patients is mainly consented. Despite this consensus surgery is denied to a significant number of patients with symptomatic aortic stenosis. Treatment of patients with severe but asymtomatic valvular heart disease is under debate. Excercise testing to detect surgical candidates is recommended but rarely performed. Evidence is evolving that subgroups of patients with asymptomatic aortic stenosis benefit from early surgery, but identification of these patients remains difficult. Advances in surgical reconstruction of leaking mitral or aortic valves have led to recommendations for earlier surgery of mitral insufficiencies; data generation for reconstructive surgery of the aortic valve is underway. Surgical experience with these techniques is of major importance in the process of deciding when to operate.

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Authors and Affiliations

  1. II. Medizinische Klinik, Klinikum der Johannes Gutenberg-Universität, Mainz, BRD

    T. Münzel

  2. Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Johannes Gutenberg-Universität Mainz, Mainz, BRD

    Manfred Dahm FECTS & C. Vahl

  3. Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätskliniken Mainz, Langenbeckstraße 1, 55131, Mainz, BRD

    Manfred Dahm FECTS

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  1. Manfred Dahm FECTS
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  2. T. Münzel
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  3. C. Vahl
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Correspondence to Manfred Dahm FECTS.

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Prof. Dr. Manfred Dahm, Jahrgang 1960, ist leitender Oberarzt und Facharzt für Chirurgie, Gefäßchirurgie, Thorax- und Kardiovaskularchirurgie an der Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie der Johannes Gutenberg-Universität in Mainz. Dort hatte er von 1978 bis 1984 sein Studium absolviert. 1986 bis 1987 war Dahm Research fellow am Albert-Einstein-College, New York. Er habilitierte sich 1993 und hat seit 1999 eine Professur inne.

Interessenkonflikt. Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Dahm, M., Münzel, T. & Vahl, C. Klappenchirurgie. Z Herz- Thorax- Gefäßchir 22, 126–131 (2008). https://doi.org/10.1007/s00398-008-0639-z

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