Zusammenfassung
Aufgrund der wachsenden Komplexität und dem zunehmenden Risikoprofil der Patienten, die Herzklappenoperationen benötigen, werden chirurgische Innovationen und neue Techniken benötigt, um optimale Operationsergebnisse erzielen zu können. Die mit der extrakorporalen Zirkulation und Ischämie assoziierten Probleme wie Reperfusionsschäden, myokardiale Ödemneigung mit nachfolgender Einschränkung der ventrikulären Funktion sowie Flüssigkeits- und Elektrolythomäostase erfordern ein optimales operatives Management, um postoperative Komplikationen zu minimieren. Ein Konzept zur Myokardprotektion, basierend auf der kontinuierlichen antegraden Perfusion am entlasteten schlagenden Herzen bei Herzklappeneingriffen wird in dieser Arbeit vorgestellt. Herzklappenoperation am schlagenden Herzen können bei Patienten mit einem hohen Risikoprofil und eingeschränkter ventrikulärer Pumpfunktion mit den beschriebenen Techniken durchgeführt werden um Myokardischämie und Reperfusionsschäden zu eliminieren.
Abstract
The increasing risk profile with complex co-morbidities of patients needing valve replacement have required novel surgical options to minimise operative complications. Myocardial oedema induced by cardioplegic arrest and incomplete elimination of ischaemia may lead to cardiac dysfunction. The ischaemia-reperfusion injury leads to apoptosis induced by accelerated production of oxygen free radicals. In order to prevent these harming effects due to ischaemic arrest new surgical techniques have been used to perform valve surgery on the empty beating heart. The concept of optimal myocardial protection by elimination of ischaemia through continuous antegrade perfusion with warm oxygenated blood has been applied to high risk patients requiring various valve procedures with good intra- and postoperative results.
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Easo, J., Horst, M., Hölzl, P. et al. Herzklappenoperationen am schlagenden Herzen. Z Herz- Thorax- Gefäßchir 21, 13–15 (2007). https://doi.org/10.1007/s00398-007-0564-6
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DOI: https://doi.org/10.1007/s00398-007-0564-6
Schlüsselwörter
- Klappenoperation
- Myokardprotektion
- Ischämie-Reperfusionsschäden
- Blutkardioplogie
- Eingriffe am schlagenden Herz