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Operative Techniken bei Mitralklappenerkrankungen

Rekonstruktion und/oder Ersatz

Surgical techniques in mitral valve diseases

Reconstruction and/or replacement

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Zusammenfassung

Die Mitralklappenerkrankungen zählen zu den häufigsten Herzklappenerkrankungen. Für die primäre Mitralinsuffizienz (MI) ist die chirurgische Mitralklappenrekonstruktion (MKR) die Therapie der Wahl, welche mit einem exzellenten Outcome und Langzeitüberleben in ausgewiesenen Zentren durchgeführt werden kann. Die operative Technik der MKR ist abhängig vom Pathomechanismus, von den morphologischen Dimensionen der Mitralklappe, vom operativen Risiko des Patienten sowie von der Expertise des Herzchirurgen. Die chirurgische und interventionelle Behandlung der sekundären MI ist Gegenstand anhaltender Diskussion. Hierbei sollte die moderate sekundäre MI durch eine chirurgische MKR bei gleichzeitiger Bypass-Versorgung versorgt werden. Bei schwerer sekundärer MI sollte, bei Vorhandensein von Risikofaktoren für ein mögliches Misslingen einer MKR, von vornherein ein Mitralklappenersatz (MKE) durchgeführt werden. Die selten gewordene Mitralklappenstenose sollte unter Berücksichtigung der Pathophysiologie, der Nebenerkrankungen, der notwendigen Antikoagulation sowie des Lebensalters mit einem biologischen oder mechanischen MKE behandelt werden. Des Weiteren bieten neue katheterbasierte Techniken des MKE weitere Behandlungsoptionen zur Reoperation von Hochrisikopatienten.

Abstract

Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.

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

    T. Noack & F.-W. Mohr

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Correspondence to T. Noack.

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T. Noack und F.-W. Mohr geben an, dass kein Interessenkonflikt besteht.

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Noack, T., Mohr, FW. Operative Techniken bei Mitralklappenerkrankungen. Herz 41, 10–18 (2016). https://doi.org/10.1007/s00059-015-4385-1

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