Zusammenfassung
Gerüstlose Bioprothesen wurden mit dem Ziel entworfen, im Vergleich zu konventionellen Bioprothesen ein physiologischeres Flussprofil und eine bessere Hämodynamik zu erreichen. Sie unterscheiden sich hinsichtlich der Implantationstechniken wesentlich von der konventionellen Aortenklappenprothese: bei letzterer zwingt ein starrer Stent den nativen Anulus in eine plane Ebene, während die Form der gerüstlosen (weichen) Bioprothese durch die chirurgische Naht festgelegt wird. Ein ungleichmäßiges Einnähen dieser Prothesen kann zu Verziehungen derselben führen, was sich, je nach Typ der gerüstlosen Prothese, eher in einer insuffizienten Schlussfähigkeit der Aortenklappentaschen oder in Obstruktionen des Lumens äußern kann. Eine solche suboptimale Implantation einer gerüstlosen Prothese vergibt nicht nur den gewünschten hämodynamischen Vorteil, sondern beeinflusst nachgewiesenermaßen Lebensqualität als auch Langzeitüberleben der Patienten. Durch Erläuterung der Implantationsprinzipien und schrittweise Beschreibung der Implantation gerüstloser Bioprothesen am Beispiel der Freestyle-Prothese möchten die Autoren zu Standardisierung der Technik und Vermeidung ungünstiger Lernkurven beitragen.
Abstract
Stentless valves were designed to improve postoperative hemodynamics in comparison to stented bioprosthesis. The implantation technique of stentless valves is very different from conventional bioprostheses: a stented bioprosthesis maintains its form, due to the rigid stent, whereas the form of a stentless valve depends on the surgical suture lines. The general goal is to snugly fit a stentless valve into the aortic root and, thereby, to ensure optimal hemodynamic results. Insufficient coaptation of the cusps and bulging of the prosthesis into the outflow tract are the results of suboptimal implantation techniques. Residual gradients after stentless valve implantation impede postoperative quality of life and long-term survival. The present paper aims to describe the principles of implantation of stentless valves and to standardize the procedure using the Freestyle prosthesis as an example. The standardization of surgical technique and the identification of common pitfalls are mandatory to avoid unfavorable learning curves and to improve quality of life and long-term survival.
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Albert, A., Ennker, J. Aortenklappenersatz mit gerüstlosen Bioprothesen. Z Herz- Thorax- Gefäßchir 24, 147–154 (2010). https://doi.org/10.1007/s00398-010-0774-1
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DOI: https://doi.org/10.1007/s00398-010-0774-1