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Chirurgischer Aortenklappenersatz

Standards, Neues und Unbekanntes

Surgical aortic valve replacement

Standards, new aspects and undetermined issues

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

Zusammenfassung

Der konventionelle, chirurgische Aortenklappenersatz zählt zu den Standardeingriffen in der Herzchirurgie. Im Jahr 2011 wurden in Deutschland 11.668 isolierte Aortenklappenoperationen durchgeführt. Diese Zahl war im Vergleich zum Vorjahr konstant. Etwa 15% dieser Eingriffe erfolgten durch eine partielle Sternotomie. Der bevorzugte Klappentyp bleiben biologische Prothesen (ca. 84%). Daneben wurden mechanische Klappenprothesen und zu geringeren Anteilen auch Homografts und Autografts eingesetzt. In einer geringen Anzahl (0,8%) konnte die Aortenklappe rekonstruiert werden (Funkat et al., Thorac Cardiovasc Surg 2012, 60:371–382). Veränderungen im Bereich der Aortenklappenchirurgie betreffen Modifikationen im operativen Zugang zur Aortenklappe und Veränderungen im Klappendesign bei biologischen Klappenprothesen. Obwohl bereits in den frühen 1960er-Jahren erstmals beschrieben, erfahren zudem „nahtlose“ Aortenklappenprothesen in den letzen Jahren eine Art Renaissance. Die vorliegende Arbeit gibt einen Überblick über Leitlinien, operative Techniken und insbesondere über Klappentypen, die für einen konventionellen Aortenklappenersatz verwendet werden.

Abstract

Conventional, i.e. surgical, aortic valve replacement represents one of the most standardized procedures in cardiac surgery. In the year 2011 a total of 11,668 isolated aortic valve replacements were performed in Germany, a volume equal to that of the previous year. Partial sternotomy was applied in approximately 15 % of all procedures and biological valves were the predominantly used prosthesis type (approximately 84 %). Mechanical prostheses, homografts and autografts were used in the minority of cases, while aortic valve reconstruction was applied in a marginal proportion of cases. Innovations in the field of aortic valve surgery concern the surgical access and the design of modern biological prostheses. Although first described in the 1960s, sutureless valves are currently experiencing a considerable renaissance. This article provides a brief overview on current guidelines, operative techniques and moreover focuses particularly on the spectrum of prosthesis types that are currently used for surgical replacement of aortic valves.

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  1. Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    M. Misfeld

  2. Klinik für Kardiovaskuläre Chirurgie, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland

    P. Akhyari

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  1. M. Misfeld
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Misfeld, M., Akhyari, P. Chirurgischer Aortenklappenersatz. Z Herz- Thorax- Gefäßchir 27, 158–165 (2013). https://doi.org/10.1007/s00398-012-0988-5

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  • DOI: https://doi.org/10.1007/s00398-012-0988-5

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