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Literaturübersicht 2018 zur Koronarchirurgie

Literature review 2018 on coronary bypass surgery

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

Zusammenfassung

In den letzten Jahren hat sich im therapeutischen Bereich der stabilen koronaren Herzkrankheit (KHK) die folgende Erkenntnis kontinuierlich konsolidiert: Die Bypass-Chirurgie bleibt der Goldstandard bei komplexer KHK, insbesondere bei Dreigefäßerkrankung mit oder ohne Hauptstammbeteiligung. Sie ist die einzige Therapieform, die nach den aktuellen Daten das Potenzial birgt, das Leben des Patienten zu verlängern. Die Bypass-Operation kann damit eine prognostische Indikation haben. Die 2018 neu erschienenen Leitlinien zur Myokardrevaskularisation haben die Unterscheidung zur perkutanen Koronarintervention (PCI) jetzt genauer differenziert und geben erstmals Empfehlungen zu operativen Details der Revaskularisation. Der Fokus dieser Literaturübersicht liegt auf den chirurgisch relevanten Aspekten. Weitere therapierelevante Informationen zu Diagnostik und medikamentöser Therapie sind ebenfalls übersichtlich zusammengefasst. Die aus dem Jahr 2018 maßgebliche Literatur zur chirurgischen Revaskularisation lässt sich in folgende Punkte untergliedern: 1. PCI vs. Bypass-Chirurgie, 2. neue diagnostische Verfahren für die Bypass-Chirurgie, 3. Rolle der medikamentösen Therapie für die Bypass-Chirurgie und 4. technische Aspekte der Bypass-Chirurgie.

Abstract

In recent years the following knowledge in the treatment of stable coronary artery disease (CAD) has been continuously consolidated: coronary bypass surgery remains the gold standard for treatment of complex stable CAD, especially for three-vessel disease with or without involvement of the main stem. According to current data it is the only treatment option with the potential to prolong life expectancy. Therefore, coronary artery bypass grafting (CABG) may be performed for prognostic reasons. The newly published 2018 guidelines on myocardial revascularization place more emphasis on the differentiation between CABG and percutaneous coronary intervention (PCI). For the first time the guidelines give recommendations for operative details of the revascularization procedure. This literature review focusses on the surgically relevant aspects and also briefly summarizes the relevant information on new diagnostic tools and the role of pharmaceutical treatment. The relevant publications in 2018 addressing surgical revascularization can be categorized as 1) PCI vs. CABG, 2) new diagnostic methods for CABG, 3) the role of drug treatment in CABG and 4) technical aspects of CABG.

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Authors and Affiliations

  1. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Jena, Friedrich-Schiller Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland

    S. Bargenda, H. Kirov, S. Freiburger, M. Diab, M. Richter, I. Valchanov, B. May &  T. Doenst

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  1. S. Bargenda
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  2. H. Kirov
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  3. S. Freiburger
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  4. M. Diab
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  5. M. Richter
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  6. I. Valchanov
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  7. B. May
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  8. T. Doenst
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Correspondence to T. Doenst.

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Interessenkonflikt

S. Bargenda, H. Kirov, S. Freiburger, M. Diab, M. Richter, I. Valchanov, B. May und T. Doenst geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Bargenda, S., Kirov, H., Freiburger, S. et al. Literaturübersicht 2018 zur Koronarchirurgie. Z Herz- Thorax- Gefäßchir 33, 425–433 (2019). https://doi.org/10.1007/s00398-019-00334-5

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  • DOI: https://doi.org/10.1007/s00398-019-00334-5

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