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Technische Durchführung der Aortenklappenrekonstruktion

Technical procedure of aortic valve reconstruction

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

Zusammenfassung

Hintergrund

Rekonstruktive Eingriffe der Aortenklappe wurden bereits in den 1950er Jahren durchgeführt. Die initialen Resultate waren wenig befriedigend, und der Ersatz der Aortenklappe wurde zum chirurgischen Standard. Die zunehmende Kenntnis um die klappenassoziierten Komplikationen hat in den letzten 20 Jahren zum wachsenden Interesse an der Rekonstruktion der Aortenklappe geführt.

Ziel der Arbeit

Die Kenntnisse der normalen geometrischen Verhältnisse der Aortenklappe und -wurzel sowie die geometrischen Voraussetzungen der idealen Rekonstruktion sind noch begrenzt. Um die Rekonstruktion reproduzierbar zu machen, wurden spezifische technische Lösungen für diese Probleme entwickelt.

Material und Methoden

Anhand von mehr als 1800 Rekonstruktionen der Aortenklappe innerhalb der letzten 17 Jahre wurden für verschiedene morphologische Befunde der Aortenklappe mit normalem Wurzeldurchmesser sowie dilatierter Aortenwurzel Strategien zur Rekonstruktion entwickelt.

Ergebnisse

Die Resultate der Rekonstruktion der Aortenklappe hängen wesentlich von den vorliegenden anatomischen Situation und den gegebenen pathologischen Veränderungen ab. Die Häufigkeit klappenassoziierter Komplikationen ist bei allen Formen der Aortenklappenrekonstruktion gering. Die Reoperation stellt die häufigste Komplikation dar; thrombembolische oder Blutungskomplikationen kommen nur im Zusammenhang mit Vorhofflimmern vor. Die Wahrscheinlichkeit einer Endokarditis betrug 0,15 % pro Patientenjahr.

Schlussfolgerung

Die Rekonstruktion der Aortenklappe ist in den letzten 10 Jahren zu einer akzeptablen Alternative des Klappenersatzes geworden. Die Wahrscheinlichkeit klappenassoziierter Komplikationen ist gering.

Abstract

Background

The first operations for aortic valve reconstruction were performed in the late 1950s. With former options it was difficult to judge the pathomechanism of valve regurgitation and the result of the operation. Replacement of the aortic valve revolutionized the treatment of valve disease due to the reproducibility. The long-term follow-up, however, showed a relevant risk of valve-related complications for both biological and mechanical prostheses.

Aim

Knowledge of the normal geometry of the aortic valve and root and the geometric prerequisites for an ideal repair result are still limited. In order to make aortic valve repair more reproducible specific technical solutions have been developed for these problems.

Material and methods

With more than 1,800 aortic valve repair operations over the last 17 years various strategies for reconstruction of different valve morphologies with normal root dimensions and also dilated aortic roots have been developed.

Results

The results of the reconstruction of the aortic valve are strongly dependent on the anatomical situation and given pathological changes. The frequency of valve-related complications is low in all forms of aortic valve repair. Reoperation is the most frequent complication and thromboembolic events and bleeding complications only occur in the context of atrial fibrillation. The probability of endocarditis is 0.15 % per patient year.

Conclusion

In the last 10 years reconstruction of the aortic valve has become an acceptable alternative to valve replacement. The probability of valve-related complications is low.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Aicher und H.-J. Schäfers geben an, dass kein Interessenkonflikt besteht. Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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  1. Klinik für Thorax- und Herz-Gefäßchirurgie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland

    D. Aicher &  H.-J. Schäfers

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  1. D. Aicher
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  2. H.-J. Schäfers
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Correspondence to H.-J. Schäfers.

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Aicher, D., Schäfers, HJ. Technische Durchführung der Aortenklappenrekonstruktion. Z Herz- Thorax- Gefäßchir 28, 96–106 (2014). https://doi.org/10.1007/s00398-013-1070-7

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  • DOI: https://doi.org/10.1007/s00398-013-1070-7

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