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Individualisierte Indikationsstellung für den isolierten Aortenklappenersatz

Methode, Zugang und Patientenselektion

Individualized assessment of indications for isolated aortic valve replacement

Methods, access and patient selection

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Bis vor circa 10 Jahren folgte die Entscheidung zum Operationsverfahren bei der isolierten Aortenklappenstenose einem relativ einfachen Algorithmus. Die meisten Patienten wurden üblicherweise über eine komplette Sternotomie operiert. Das Alter des Patienten und evtl. Kontraindikationen für eine Antikoagulationstherapie stellten die wichtigsten Kriterien der Wahl der Klappenprothese dar. Operationsverfahren, Zugangsweg und Klappenprothese sind heute deutlich differenzierter zu wählen. Kathetergestützte Aortenklappenimplantation (TAVI), weniger invasive Zugangswege (im Vergleich zur kompletten Sternotomie) und neue Klappenprothesen („Rapid-deployment“-Klappen) ermöglichen ein individuell abgestimmtes Therapiekonzept bei Aortenklappenstenose. Die erweiterte präoperative Planung mit Computertomographie (CT)-Diagnostik und -Interpretation ist eine notwendige Voraussetzung. Der vorliegende Beitrag gibt eine Übersicht über einen möglichen Entscheidungsalgorithmus zu den heute zur Verfügung stehenden Verfahren, zu Zugangswegen und zur Wahl der Klappenprothese bei der isolierten Operation an der Aortenklappe im Erwachsenenalter.

Abstract

Approximately 10 years ago the surgical treatment of aortic valve stenosis followed a relatively simple algorithm. The most important criteria for prosthesis selection were the age of the patient and the potential contraindications for anticoagulation. The surgical procedure for the majority of patients was via median sternotomy. Nowadays the decision for the operative procedure, surgical access and selection of the prosthesis is more sophisticated. Transcatheter aortic valve implantation (TAVI), less invasive surgical access routes (compared to complete sternotomy) and new valve prostheses (rapid deployment valves) enable an individually shaped concept depending on the anatomy of the patient, morphology and pathology of the valve and individual comorbidities. An extended preoperative planning which includes new 3‑D computed tomography (CT) technology is an essential prerequisite. This article presents an overview of a possible decision algorithm with respect to the currently available procedures, approaches and selection of valve prostheses for isolated operations on aortic valves in adulthood.

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  1. Herz- und Gefäß-Klinik Bad Neustadt, Salzburger Leite 1, 97616, Bad Neustadt a.d. Saale, Deutschland

    A. Lenos & A. Diegeler

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  1. A. Lenos
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  2. A. Diegeler
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Correspondence to A. Lenos.

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A. Lenos und A. Diegeler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Lenos, A., Diegeler, A. Individualisierte Indikationsstellung für den isolierten Aortenklappenersatz. Z Herz- Thorax- Gefäßchir 30, 218–224 (2016). https://doi.org/10.1007/s00398-016-0082-5

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  • DOI: https://doi.org/10.1007/s00398-016-0082-5

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