Zusammenfassung
Operationen an der Aortenklappe sind nach den Koronaroperationen die häufigsten kardiochirurgischen
Eingriffe. Verursacht durch die demographische Entwicklung kommt es zu einer Verschiebung
des Operationsalters in die 7. - 9. Lebensdekade. Im Rahmen des Aortenklappenersatzes
werden jenseits des 65. Lebensjahres biologische Klappenprothesen als Aortenklappensubstitute
empfohlen. Einerseits unterliegen die xenogenen Prothesen in dieser Altersgruppe nur
einer langsamen Degeneration und andererseits sind insbesondere die älteren Patienten
durch Komplikationen einer Cumarintherapie bedroht. Die modernen klappenerhaltenden
Operationsverfahren können auch bei den älteren Patienten mit geringem, kalkulierbarem
Risiko eingesetzt werden. Die Sterblichkeit an Aortenklappenoperationen ist bei den
älteren Patienten etwas höher als bei vergleichbaren jüngeren Patienten. Sie wird
entscheidend von weiteren Risikofaktoren, wie dem klinischen Stadium und der Komorbidität
beeinflusst. Schlussfolgernd sollte ein Aortenklappenersatz auch bei älteren, symptomatischen
Patienten immer erwogen werden. Die Wahl des Operationsverfahrens bleibt eine patientenspezifische
Notwendigkeit, die zwischen dem Patienten, dem Kardiologen und dem Herzchirurgen erfolgen
sollte.
Summary
Aortic valve procedures represent the second most frequent surgical intervention in
cardiac surgery. Due to the demographic developments there is a shift into the seventh
to ninth decade of age. For patients beyond 65 years biological valve prostheses are
recommended. In these patients xenografts are showing only a slow degeneration. Furthermore,
especially these patients are threatened by complications caused by cumarine therapy.
Modern valve-sparing procedures might also be used in old patients with an insurable
risk. Mortality is slightly increased in old patients compared to younger patients.
However, additional risk factors like clinical stage as well as co-morbidity affect
the mortality significantly. The specific operative procedure has to select with respect
to the individual situation of the patient. In conclusion, aortic valve surgery should
be taken into account also in older, symptomatic patients.
Literatur
- 1 Leitlinien der Deutschen Gesellschaft für Herz-, Thorax- und Gefäßchirurgie .Aortenklappe. AWMF-Leitlinien-Register
Nr. 011/004 2001
- 2 Acar J, Elias J, Luxereau P. Aortic stenosis and mixed aortic valve disease. London:
ICR Publishers In: Acar J, Bodnar E, editors. Textbook of acquired heart valve disease
1995 Volume I: 454-486
- 3
Albes J, Wahlers T.
Valve sparing root reduction plasty in aortic aneurysm: the Jena technique.
Ann Thorac Surg.
2003;
74
1031-1033
- 4
Anttila V, Heikkinen J, Biancari F.
A retrospective comparative study of aortic valve replacement with St. Jude Medical
and Medtronic-Hall prostheses: a 20-year follow-up study.
Scand Cardiovasc J.
2002;
36
53-59
- 5 Bodnar E. Mechanical heart valves. London: ICR Publishers In: Acar J, Bodnar E,
editors. Textbook of acquired heart valve disease 1995 Volume II: 965-1001
- 6
Bonow R O, Carabello B, de Leon A C. et al .
ACC/AHA guidelines for the management of patients with valvular heart disease: executive
summary. A report of the American College of Cardiology/American Heart Association
Task Force on Practice Guideines (Committee on Management of Patients With Valvular
Heart Disease).
Circulation.
1998;
98
1949-1984
- 7
Carrel T P, Berdat P, Englberger L, Eckstein F, Immer F, Seiler C. et al .
Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary
hemodynamic and clinical results.
J Heart Valve Dis.
2003;
12
752-757
- 8
Casselmann F P, Bots M L, van Lommel W, Knaepen P J, Lensen R, Vermeulen F EE.
Repeated thromboembolic and bleeding events after mechanical aortic valve replacement.
Ann Thorac Surg.
2001;
71
1172-1180
- 9
David T E, Feindel C M.
An aortic valve-sparing operation for patients with aortic incompetence and aneurysm
of the ascending aorta.
J Thorac Cardiovasc Surg.
1992;
103
617-622
- 10
David T E, Ivanov J, Armstrong S, Feindel C M, Cohn G.
Late results of heart valve replacement with the Hancock II bioprosthesis.
J Thorac Cardiovasc Surg.
2001;
121
268-278
- 11
De Oliveira N C, David T E, Ivanov J. et al .
Results of surgery for aortic root aneurysm in patients with Marfan syndrom.
J Thorac Cardiovasc Surg.
2003;
125
789-796
- 12
Florath I, Rosendahl U, Mortasawi A. et al .
Current determinants of operative mortality in 1400 patients requiring aortic valve
replacement.
Ann Thorac Surg.
2003;
76
75-83
- 13
Franke U FW, Wahlers T.
Patientenadaptierte chirurgische Therapie von Aortenklappenfehlern.
Dtsch Arztebl.
2004;
101A
1092-1098
- 14
Graeter T, Kindermann M, Fries R, Langer F, Schaefers H J.
Comparison of aortic valve gradient during exercise after aortic valve reconstruction.
Chest.
2000;
118
1271-1277
- 15
Harringer W, Pethig K, Hagl C, Wahlers T, Cremer J, Haverich A.
Replacement of ascending aorta with aortic valve reimplantation: midterm results.
Eur J Cardiothorac Surg.
1999;
15
803-807
- 16 Jamieson W RE, Lichtenstein S V. Cardiac valvular replacement devices: residual
problems and innovative investigative technologies. San Francisco: Universal Medical
Press In: Szabo Z, Lewis JE, Fantini GA, Savalgi RS, editors. Surgical technology
international VII 1998: 229-248
- 17
Kaempchen S, Guenther T, Toschke M, Grunkemeier G L, Wottke M, Lange R.
Assessing the benefit of biological valve prostheses: cumulative incidence (actual)
vs. Kaplan-Meier (actuarial) analysis.
Eur J Cardiothorac Surg.
2003;
23
710-714
- 18
Kallenbach K, Pethig K, Leyh R G, Baric D, Haverich A, Harringer W.
Acute dissection of the ascending aorta: first results of emergency valve sparing
aortic root reconstruction.
Eur J Cardiothorac Surg.
2002;
22
218-222
- 19
Kalmar P, Irrgang E.
Cardiac surgery in Germany during 2003: A report by the German Society for Thoracic
and Cardiovascular Surgery.
Thorac Cardiov Surg.
2004;
52
312-317
- 20
Khan S S, Trento A, DeRobertis M, Kass R M, Sandhu M, Czer L SC. et al .
Twenty years comparison of tissue and mechanical valve replacement.
J Thorac Cardiovasc Surg.
2001;
122
257-269
- 21
Langley S M, Rooney S J, Dalrymple-Hay M J, Spencer J M, Lewis M E, Pagano D. et al
.
Replacement of the proximal aorta and aortic valve using a composite bileaflet prosthesis
and gelatin-impregnated polyester graft (Carbo-Seal): early results in 143 patients.
J Thorac Cardiovasc Surg.
1999;
118
1014-1020
- 22
Lund O, Nielsen S L, Arildsen H, Ilkjaer L B, Pilegaard H K.
Standard aortic St. Jude valve at 18 years: performance profile and determinants of
outcome.
Ann Thorac Surg.
2000;
69
1459-1465
- 23
Mahoney C B, Miller D C, Khan S S, Hill J D, Cohn L H.
Twenty-year, three-institution evaluation of the Hancock modified orifice aortic valve
durability. Comparison of actual and actuarial estimates.
C irculation.
1998;
98
II88-II94
- 24
Medalion B, Blackstone E H, Lytle B W, White J, Arnold J H, Cosgrove D M.
Aortic valve replacement: is valve size important?.
J Thorac Cardiovasc Surg.
2000;
119
963-974
- 25
Myken P, Bech-Hanssen O, Phipps B, Caidahl K.
Fifteen years follow up with the St. Jude Medical Biocor porcine bioprosthesis.
J Heart Valve Dis.
2000;
9
415-422
- 26
Pethig K, Milz A, Hagl C, Harringer W, Haverich A.
Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve
failure.
Ann Thorac Surg.
2002;
73
29-33
- 27
Pibarot P, Dumesnil J G.
Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve
position and its prevention.
J Am Coll Cardiol.
2000;
36
1131-1141
- 28
Roberts W C.
The congenital bicuspid aortic valve. A study of 85 autopsy cases.
Am J Cardiol.
1970;
26
72-83
- 29
Sarsam M A, Yacoub M.
Remodeling of the aortic valve annulus.
J Thorac Cardiovasc Surg.
1993;
105
435-438
- 30
Schaefers H J, Langer F, Aicher D, Graeter T, Wendler O.
Remodeling of the aortic root and reconstruction of the bicuspid aortic valve.
Ann Thorac Surg.
2000;
70
542-546
- 31
Unger F, Horstkotte D, Ghosh P. et al .
Standards and concepts in valve surgery. A report of the task force of European Heart
Institute (EHI) of the European Academy of Science and Arts and the International
Society of Cardiothoracic Sorgeons (ISCTS).
Thorac Cardiov Surg.
2000;
48
175-182
- 32
Vrandecic M, Fantini F A, Filho B G, De Oliveira O C, da Costa I M, Vrandecic E.
Retrospective clinical analysis of stented vs. stentless porcine aortic bioprostheses.
Eur J Cardiothorac Surg.
2000;
18
46-53
- 33
Wahlers T.
Aortenklappeninsuffizienz: Wann ist der optimale Operationszeitpunkt?.
Dtsch Med Wochenschr.
2003;
128
2145-2148
- 34
Westaby S, Horton M, Jin X Y. et al .
Survival advantage of stentless aortic bioprostheses.
Ann Thorac Surg.
2000;
70
785-791
- 35
Zehr K J, Orszulak T A, Mullany C J, Matloobi A, Daly R C, Dearani J A. et al .
Surgery for aneurysms of the aortic root: a 30-year experience.
Circulation.
2004;
110
1364-1371
Priv.-Doz. Dr. med. Ulrich Franke
Klinik für Herz-, Thorax- und Gefäßchirurgie, Friedrich-Schiller-Universität
Erlanger Allee 101
07740 Jena
Phone: 03641/9322901
Fax: 03641/9322902
Email: Ulrich.Franke@med.uni-jena.de
