Aktuelle Kardiologie 2015; 4(05): 320-325
DOI: 10.1055/s-0035-1558071
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Revaskularisation bei schlechter LV-Funktion

Revascularization in Patients with Reduced Left Ventricular Function
H. Möllmann
1   Kerckhoff-Klinik Bad Nauheim, Bad Nauheim
,
H. Dörge
2   Herz-Thorax-Zentrum Fulda, Klinik für Herz- und Thoraxchirurgie, Fulda
› Author Affiliations
Further Information

Publication History

Publication Date:
26 October 2015 (online)

Zusammenfassung

Die Prognose von Patienten mit eingeschränkter linksventrikulärer Funktion und interventionsbedürftiger koronarer Herzerkrankung ist deutlich eingeschränkt. Frühe Studien zum Vergleich medikamentöser mit operativer Therapie haben nachgewiesen, dass gerade diese Hochrisikopatienten von einer kompletten Revaskularisierung profitieren. Die Datenlage ist deutlich dünner für den Vergleich zwischen den beiden Revaskularisationsmethoden PCI und Bypassoperation. Dies liegt vor allen daran, dass in den meisten Studien eine eingeschränkte linksventrikuläre Funktion als Ausschlusskriterium definiert ist. Dementsprechend müssen hier Ergebnisse aus anderen Patientenkollektiven extrapoliert werden. Komplexe Koronaranatomien mit multiplen Stenosen und hoher Wahrscheinlichkeit großer Stentlängen sollten demnach genauso wie Diabetiker eher chirurgisch versorgt werden. Die PCI kann bei geringerer Stenosekomplexität eine wertvolle und weniger invasive Alternative sein. Um eine möglichst optimale Behandlung für diese häufig schwerkranken Patienten zu gewährleisten, sollte eine individuelle Therapiefestlegung durch das Heart Team erfolgen.

Abstract

Patients with reduced left ventricular (LV) function due to coronary artery disease are at risk of both sudden cardiac death and increased long-term mortality. Early landmark clinical trials proved benefits of coronary artery bypass grafting (CABG) compared to medical therapy with respect to symptoms and prognosis. Data comparing percutaneous coronary intervention (PCI) and CABG in coronary patients with depressed LV function are scarce because these patients were excluded in most revascularization trials. However, data derived from subgroups, registries and meta-analyses suggest preference of CABG in complex multi-vessel disease, whereas PCI is a valuable less invasive alternative in less complex coronary anatomy. The choice of the procedure should be made by the heart team.

 
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