Operative Mitralklappenrekonstruktion – State of the art

Abstract

In the last two decades a broad spectrum of surgical techniques for mitral valve reconstruction has been developed. Mitral valve repair is the gold standard for surgical correction of mitral regurgitation. The operative mortality is low (< 2 %) and the long-term results are excellent. The operation should be performed before symptoms occur or LV function is impaired. Today surgical techniques that avoid leaflet resection are used more frequently.

Mitral valve surgery especially for patients with complex mitral valve pathology requires a well trained and experienced surgeon, who is familiar with minimally invasive surgery. Therefore these patients should be referred to high volume centers specialized in mitral valve repair.

Kernaussagen

• Die in den zurückliegenden Jahren rasante Entwicklung vieler Techniken zur Mitralklappenrekonstruktion hat die Behandlung der Mitralinsuffizienz buchstäblich revolutioniert.

• Aufgrund der sehr niedrigen Letalität von < 2 % und der exzellenten Langzeitergebnisse ist die Klappenrekonstruktion heute der Goldstandard in der Mitralklappenchirurgie.

• Die Operation sollte frühzeitig, noch vor Auftreten von Beschwerden bzw. vor einer einsetzenden Verschlechterung der Pumpfunktion des Herzens, durchgeführt werden.

• Das mit dem operativen Eingriff verbundene Risiko ist gering. In zunehmendem Maß werden Rekonstruktionstechniken eingesetzt, die auf eine Resektion von Segelanteilen verzichten. Reoperationen sind selten erforderlich.

• Die Klappenrekonstruktion über einen minimalinvasiven Zugang gerade bei Patienten mit komplexer Klappenpathologie erfordert vom Chirurgen Erfahrung im Umgang mit unterschiedlichen Rekonstruktionstechniken. Da der Chirurg seine Expertise nur dann gewinnen und auch erhalten kann, wenn er diese Techniken häufig anwendet, sollte auch die rekonstruktive Behandlung der Mitralklappe in spezialisierten Zentren durchgeführt werden.

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