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Chirurgische Therapie der infektiösen Endokarditis

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Surgical therapy of infectious endocarditis

Current overview

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Trotz der kontinuierlichen Verbesserung der medikamentösen und chirurgischen Therapie ist die infektiöse Endokarditis (IE) auch heute noch eine lebensbedrohliche Erkrankung mit einer hohen Mortalität und Morbidität. Der Erfolg der chirurgischen Therapie hängt von der rechtzeitigen Indikationsstellung ab; dabei ist eine frühzeitige interdisziplinäre Kooperation von entscheidender Bedeutung. Indikationen zur Operation sind eine bestehende Herzinsuffizienz, eine persistierende Infektion und ein erhöhtes Embolierisiko. Bei Patienten, die durch eine Herzinsuffizienz symptomatisch werden, ist das rechtzeitige Erkennen einer beginnenden kardialen Dekompensation wesentlich. Bei Patienten mit Vegetationen hängt der optimale Zeitpunkt für eine chirurgische Therapie von der Vorhersage des Embolierisikos ab. Weiterhin haben evtl. vorhandene extrakardiale septische Embolien und Begleiterkrankungen des Patienten Einfluss auf die Indikationsstellung. Im Zweifel ist die frühzeitige Operation vor Eintritt von Komplikationen empfehlenswert. Ist ein Klappenersatz erforderlich, eignen sich außer einem Homograft als „Goldstandard“ auch biologische oder mechanische Prothesen.

Abstract

Despite the continuous improvement of medicinal and surgical therapy infectious endocarditis (IE) is still a life-threatening disease with a high mortality and morbidity. The success of surgical therapy greatly depends on the optimal timing; therefore, early interdisciplinary cooperation is essential. Indications for surgery are existing heart failure, persistent infection, as well as an elevated risk of embolism. In patients presenting with heart failure early diagnosis of decompensation is crucial, whereas in patients with vegetations the predicted risk of embolism determines the optimal timing of surgery. Further parameters influencing the indications for surgery are the presence of extracardiac septic emboli and other comorbidities. In doubtful cases, surgical therapy is recommended before complications occur. If valve replacement is required, homograft is considered the gold standard; however, biological or mechanical valve prostheses are also suitable.

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Danksagung

Wir danken Anne Carney und Anne Gale für redaktionelle Unterstützung.

Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Siniawski, M. Musci, C. Knosalla und R. Hetzer geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Chirurgie der angeborenen Herzfehler/Kinderherzchirurgie, Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    H. Siniawski,  M. Musci, C. Knosalla & R. Hetzer

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  1. H. Siniawski
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  2. M. Musci
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  3. C. Knosalla
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  4. R. Hetzer
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Correspondence to M. Musci.

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H. Siniawski und M. Musci haben die Erstautorenschaft geteilt.

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Siniawski, H., Musci, M., Knosalla, C. et al. Chirurgische Therapie der infektiösen Endokarditis. Z Herz- Thorax- Gefäßchir 29, 25–35 (2015). https://doi.org/10.1007/s00398-014-1139-y

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