Der Klinikarzt 2017; 46(10): 500-505
DOI: 10.1055/s-0043-120516
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Chirurgische Therapie der Herzinsuffizienz

Aktueller Stand
Gloria Färber
,
Tim Sandhaus
,
Michel Noutsias
,
Christian Schulze
,
Torsten Doenst
Further Information

Publication History

Publication Date:
24 October 2017 (online)

Zusammenfassung

Patienten mit Herzinsuffizienz stellen eine besondere Herausforderung für den Herzchirurgen dar und erfordern u. a. aufgrund der großen Erfolge der medikamentösen Therapie einen interdisziplinären und individualisierten Therapieansatz. Grundsätzlich ergibt sich die Indikation für ein operatives Vorgehen aus symptomatischer und/oder prognostischer Sicht. Für die Therapie der Herzinsuffizienz ergeben sich folgende chirurgische Behandlungsoptionen. Eine Bypassoperation kann das Leben verlängern und die Symptome lindern. Ein Aortenklappenersatz kann bei hochgradigem Vitium das Leben verlängern und die Symptome lindern. Eine Mitralklappenoperation kann bei funktioneller Mitralklappeninsuffizienz die Symptome lindern. Eine Herztransplantation oder ventrikuläre Herz­unterstützungssysteme können die Symptome lindern und das Leben verlängern. Im Folgenden wird in kondensierter Form der aktuellen Stand der chirurgischen Therapiemöglichkeiten beschrieben.

 
  • Literatur

  • 1 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-2200
  • 2 Sipahi I, Akay MH, Dagdelen S. et al. Coronary artery bypass grafting vs percutaneous coronary intervention and long-term mortality and morbidity in multivessel disease: meta-analysis of randomized clinical trials of the arterial grafting and stenting era. JAMA 2014; 174: 223-230
  • 3 Petrie MC, Jhund PS, She L. et al. Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2016; 134: 1314-1324
  • 4 Velazquez EJ, Lee KL, Jones RH. et al. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. New Engl J Med 2016; 374: 1511-1520
  • 5 Windecker S, Kolh P, Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35: 2541-2619
  • 6 Cooley DA, Hallman GL. Surgical treatment of left ventricular aneurysm: experience with excision of postinfarction lesions in 80 patients. Progress in cardiovascular diseases 1968; 11: 222-228
  • 7 Jones RH, Velazquez EJ, Michler RE. et al. Coronary bypass surgery with or without surgical ventricular reconstruction. New Engl J Med 2009; 360: 1705-1717
  • 8 Cinq-Mars A, Voisine P, Dagenais F. et al. Risk factors of mortality after surgical correction of ventricular septal defect following myocardial infarction: Retrospective analysis and review of the literature. Int J Cardiol 2016; 206: 27-36
  • 9 Faerber GMA, Diab M, Doenst T. A Multiple Patch Technique for the Treatment of Ischemic Ventricular Septum Defects or Contained Ventricular Rupture. Interact Cardiovasc Thorac Surg. 2014 19. Suppl 1: Np
  • 10 Vahanian A, Alfieri O, Andreotti F. et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451-2496
  • 11 Ben-Dor I, Maluenda G, Iyasu GD. et al. Comparison of outcome of higher versus lower transvalvular gradients in patients with severe aortic stenosis and low (< 40 %) left ventricular ejection fraction. Am J Cardiol 2012; 109: 1031-1037
  • 12 Clavel MA, Webb JG, Rodes-Cabau J. et al. Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Circulation 2010; 122: 1928-1936
  • 13 Rossi A, Dini FL, Faggiano P. et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 2011; 97: 1675-1680
  • 14 Michler RE, Smith PK, Parides MK. et al. Two-Year Outcomes of Surgical Treatment of Moderate Ischemic Mitral Regurgitation. New Engl J Med 2016; 374: 1932-1941
  • 15 Regueiro A, Granada JF, Dagenais F. et al. Transcatheter Mitral Valve Replacement: Insights From Early Clinical Experience and Future Challenges. J Am Coll Cardiol 2017; 69: 2175-2192
  • 16 Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004; 43: 405-409
  • 17 Chang JD, Manning WJ, Ebrille E. et al. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation. J Am Coll Cardiol 2017; 69: 2331-2341
  • 18 Faerber G, Siordia Dawson R, Diab M. et al. Simplified Minimally-Invasive Technique for Safe Isolated Tricuspid Re-Do Surgery. In, EACTS Annual Meeting 2016; Barcelona: 2016
  • 19 Rodes-Cabau J, Hahn RT, Latib A. et al. Transcatheter Therapies for Treating Tricuspid Regurgitation. J Am Coll Cardiol 2016; 67: 1829-1845
  • 20 Lund LH, Edwards LB, Dipchand AI. et al. The Registry of the International Society for Heart and Lung Transplantation: Thirty-third Adult Heart Transplantation Report-2016; Focus Theme: Primary Diagnostic Indications for Transplant. J Heart Lung Transplant 2016; 35: 1158-1169
  • 21 Estep JD, Starling RC, Horstmanshof DA. et al. Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients: Results From the ROADMAP Study. J Am Coll Cardiol 2015; 66: 1747-1761
  • 22 Mehra MR, Naka Y, Uriel N. et al. A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure. New Engl J Med 2017; 376: 440-450
  • 23 Gustafsson F, Rogers JG. Left ventricular assist device therapy in advanced heart failure: patient selection and outcomes. Eur Journal Heart Fail 2017; 19: 595-602
  • 24 Boyle AJ, Ascheim DD, Russo MJ. et al. Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification. J Heart Lung Transplant 2011; 30: 402-407