Herzchirurgische Eingriffe beim älteren Patienten

Zusammenfassung

In den vergangenen Jahren ist die Anzahl herzchirurgischer Eingriffe bei älteren Patienten weltweit angestiegen. Der Anteil über 75-jährigen Patienten liegt derzeit bei 20 % und steigt weiter an. Überwiegend werden in dieser Altersgruppe Eingriffe an den Herzklappen (häufig an der Aortenklappe), die aortokoronare Bypassoperation oder die Kombination aus Aortenklappenersatz und aortokoronarer Bypassoperation durchgeführt. Im Gegensatz dazu werden Verfahren der chirurgischen Herzinsuffizienztherapie wie die linksventrikuläre Reduktionsplastik, die Implantation von mechanischen Unterstützungssystemen (Assist Device) oder die Herztransplantation in dieser Patientengruppe nur sehr selten eingesetzt oder gelten wegen des höheren Alters als kontraindiziert. Schwerpunkte dieser Übersichtsarbeit ist die chirurgische Therapie der koronaren Herzerkrankung und die Kombination von Bypassoperation und Klappenersatz. Ein weiterer Bestandteil sind altersspezifische Risikofaktoren und chirurgische Optionen zur Senkung der perioperativen Morbidität und Letalität.

Summary

Heart surgery has been performed in an increasing number of elderly patients in the recent years. Currently about 20 % of all patients in cardiac surgery are older than 75 years, however their number is increasing constantly. Valve replacement (mainly aortic valve replacement, AVR), coronary artery bypass grafting (CABG) or combined procedures (AVR and CABG) are the most common procedures in the elderly. However, surgical therapy of heart failure, implantation of assist devices or cardiac transplantation have been performed only in a limited number of elderly patients. Surgical pathways in the therapy of coronary artery disease or valve diesease are described. Furthermore, age related morbidity and mortality and related surgical options to improve the outcome are discussed.

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