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Die interventionelle Therapie der Mitralklappeninsuffizienz

Interventional therapy of mitral valve regurgitation

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

Zusammenfassung

Die chirurgische Mitralklappenrekonstruktion ist die Therapie der Wahl bei hochgradiger Mitralklappeninsuffizienz mit exzellenten Ergebnissen insbesondere bei degenerativer Ätiologie. Viele Patienten bleiben allerdings aufgrund relevanter Komorbiditäten und eines hohen operativen Risikos unbehandelt. Gerade diesen Patienten könnte die Entwicklung interventioneller Verfahren zugutekommen. Dabei ahmen viele der perkutanen Techniken erprobte chirurgische Techniken zu Anuloplastie, Valvuloplastie oder Klappenersatz nach. Die an die Alfieri-Naht angelehnte Therapie mit dem MitraClip® hat in einem randomisierten Vergleich mit der chirurgischen Mitralklappenrekonstruktion vielversprechende Ergebnisse erzielt. Aufgrund des guten Sicherheitsprofils kann diese Technik bei Patienten mit funktioneller Mitralklappeninsuffizienz und reduzierter linksventrikulärer Funktion bereits als komplementär zur chirurgischen Therapie eingestuft werden. Eine enge interdisziplinäre Zusammenarbeit zwischen Kardiologen und Herzchirurgen ist dabei entscheidend für die erfolgreiche Implementierung eines interventionellen Mitralklappenprogramms in einem Herzzentrum.

Abstract

Surgical mitral valve repair remains the gold standard treatment for significant mitral regurgitation achieving excellent results especially in degenerative mitral valve disease. Due to comorbidities and high surgical risk, a substantial number of patients are left untreated. It is especially for these patients that interventional and less invasive devices need to be explored. Most of the currently investigated technologies mimic surgical methods of valvuloplasty, annuloplasty, and valve replacement. Edge-to-edge repair with the MitraClip® device imitates the Alfieri stitch and obtained encouraging results in a randomized trial compared with surgical mitral valve repair. Due to its high safety profile, this approach can already be seen as complimentary to surgery for patients with functional mitral regurgitation and poor left ventricular function. A close interdisciplinary collaboration of cardiologists and cardiac surgeons is essential for a successful interventional mitral valve program.

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Authors and Affiliations

  1. Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Martinistr. 52, 20246, Hamburg, Deutschland

    M. Seiffert, L. Conradi, H. Reichenspurner &  H. Treede

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  1. M. Seiffert
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  2. L. Conradi
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  3. H. Reichenspurner
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  4. H. Treede
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Correspondence to H. Treede.

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Seiffert, M., Conradi, L., Reichenspurner, H. et al. Die interventionelle Therapie der Mitralklappeninsuffizienz. Z Herz- Thorax- Gefäßchir 25, 258–265 (2011). https://doi.org/10.1007/s00398-011-0876-4

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  • DOI: https://doi.org/10.1007/s00398-011-0876-4

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