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Herausforderung Porzellanaorta

Chirurgische (Un-)Möglichkeiten

Challenge porcelain aorta

Surgical (im)possibilities

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

Zusammenfassung

Das Krankheitsbild der schweren aortalen Atherosklerose stellt den Herz- und Gefäßchirurgen vor ernsthafte und komplexe Probleme: Ausgelöst durch intraoperative Manipulationen an der Aorta zieht die operative Behandlung dieser Erkrankung ein signifikant erhöhtes Risiko für zerebrale Embolisationen, Aortendissektionen und gravierende Gefäßwandverletzungen nach sich. Besonders bei älteren Patienten mit einer „Porzellanaorta“ geht die herzchirurgische Therapie mit hohen Morbiditäts- und Letalitätsraten einher. Aufgrund der vielfältigen morphologischen Erscheinungsbilder einer verkalkten Aorta ascendens stellt die adäquate operative Strategie eine absolute Herausforderung dar. Daher sind umfassende perioperative Untersuchungen der Aorta wie Computertomographie (CT), transösophageale Echokardiographie (TEE) und epiaortaler Ultraschall unverzichtbare Mittel zur Garantiesicherung und Optimierung der Operationsmethode. Dennoch bleibt ein hohes Restrisiko des intraoperativen Managements per se bestehen: Kritische Operationsschritte sind die arterielle Kanülierung, das Abklemmen der Aorta, die Aortotomie und die abschließende Aortennaht. Es gibt verschiedene Herangehensweisen, sich der Problematik einer schwer verkalkten Aorta zu nähern; bislang existiert jedoch noch kein generelles Einvernehmen darüber, wie mit diesem Erkrankungsbild – insbesondere mit der seltenen Porzellanaorta – standardmäßig umgegangen werden soll.

Abstract

Severe aortic atherosclerosis represents a serious problem in cardiovascular surgery as it involves a significant risk of cerebral embolization, aortic dissection and mural laceration by manipulation and clamping maneuvres. Therefore, aortic cross-clamping of the aorta during surgical treatment is associated with high mortality and morbidity rates especially in elderly patients with a porcelain aorta. As a result the cardiovascular surgeon faces an operative challenge due to the multifaceted morphological symptoms of a calcified ascending aorta. Extensive perioperative examination of the aorta using computed tomography (CT), transesophageal echocardiography (TEE) and epiaortic ultrasound is an indispensable tool to optimize surgical treatment. The operative procedure itself complicates safe cannulation as well as cross-clamping and causes difficulties for aortotomy and suturing. Several techniques have been proposed to manage various aspects of these problems and to minimize the risk of cerebral embolization. So far, there has been no common agreement about how to deal with significantly modified atherosclerotic aortas, especially the porcelain aorta.

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Danksagung

Die Autoren danken Katrin Pitzer-Hartert M.A. für die Anfertigung der Zeichnungen und die redaktionelle Mitarbeit bei der Erstellung des Manuskripts.

Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Hartert, A. Abugameh und C.-F. Vahl geben an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    M. Hartert, A. Abugameh & C.-F. Vahl

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  1. M. Hartert
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  2. A. Abugameh
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  3. C.-F. Vahl
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Correspondence to M. Hartert.

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Hartert, M., Abugameh, A. & Vahl, CF. Herausforderung Porzellanaorta. Z Herz- Thorax- Gefäßchir 27, 391–398 (2013). https://doi.org/10.1007/s00398-013-1039-6

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  • DOI: https://doi.org/10.1007/s00398-013-1039-6

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