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Therapie der erweiterten Aorta ascendens

Bikuspide vs. trikuspide Aortopathie

Treatment of dilatation of the ascending aorta

Bicuspid versus tricuspid aortic valve pathologies

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

Zusammenfassung

Hintergrund

Die Entwicklung der individualisierten Medizin fordert eine bessere Risikoprädiktion der aortalen Ereignisse und eine differenzierte Behandlung der erweiterten Aorta ascendens.

Ziel der Arbeit

Der vorliegende Beitrag bietet eine Übersicht zu traditionellen und neuartigen Markern zur Risikoprädiktion der aortalen Ereignisse sowie zur Evidenzlage differenzierter Behandlungskonzepte der bi- vs. trikuspiden Aortopathie.

Material und Methode

Hierzu wurde die aktuelle Literatur bezüglich der modernen Marker zur Risikoprädiktion der aortalen Komplikationen bei erweiterter Aorta ascendens sowie der differenzierten Behandlungskonzepte der bi- vs. trikuspiden Aortopathie analysiert.

Ergebnisse

Der maximale Diameter der proximalen Aorta allein ist kein verlässlicher Indikator, um eine Risikostratifikation bezüglich der Aortopathie vorzunehmen; dies gilt insbesondere unter Berücksichtigung der Heterogenität der aortalen Pathologie. Aktuelle Literaturdaten deuten auf das Vorliegen unterschiedlicher Aortopathien innerhalb des Krankheitsbildes der bikuspiden Aortenklappe hin. Diese haben einen unterschiedlichen Ursprung und eine unterschiedliche Prognose und können dadurch eine spezialisierte Behandlungsform erforderlich machen. Basierend auf den Studienergebnissen der letzten Jahre ergeben sich eindeutige Parallelen zwischen der bi- und der trikuspiden Aortopathie, die allerdings bislang noch nicht anhand prospektiver Studien untersucht wurden.

Schlussfolgerungen

Die individualisierte Risikoanalyse und Therapieentscheidung bei erweiterter Aorta ascendens bedürfen zukünftig der Etablierung von prognostisch-basierten Biomarkern in Kombination mit traditionellen Risikofaktoren.

Abstract

Background

The development of individualized treatment concepts necessitates better risk prediction models for adverse aortic events and patient-tailored treatment strategies for dilatation of the ascending aorta.

Objectives

This article provides an overview of traditional and modern markers for risk prediction of adverse aortic events and the state of the art evidence for specific treatment concepts of bicuspid versus tricuspid valve aortopathies.

Material and methods

A systematic analysis of the current literature was carried out taking into account the implementation of modern biomarkers for risk prediction of adverse aortic events and differentiated treatment concepts for bicuspid versus tricuspid valve aortopathies.

Results

The maximum cross-sectional aortic diameter alone is insufficient to provide reliable information for risk stratification with respect to the aortopathy, especially considering the heterogeneous nature of ascending aortic disease. The current literature indicates the presence of marked heterogeneity in the symptoms of diseases of the bicuspid aortic valve, which have different origins and a different prognosis and can therefore necessitate a specialized form of treatment. Based on the study results from recent years there are clear parallels between bicuspid and tricuspid valve aortopathies which, however, have not yet been investigated in prospective studies.

Conclusion

The individualized risk analysis and therapy decision-making process for dilatation of the ascending aorta necessitate the future establishment of prognosis-based biomarkers in combination with traditional risk factors.

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Danksagung

Die Autoren danken Frau P. Seiler für die Hilfe beim Erstellen des Manuskriptes.

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Correspondence to E. Girdauskas.

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Interessenkonflikt

E. Girdauskas, Y. von Kodolitsch, C. Detter und H. Reichenspurner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Girdauskas, E., von Kodolitsch, Y., Detter, C. et al. Therapie der erweiterten Aorta ascendens. Z Herz- Thorax- Gefäßchir 31, 7–15 (2017). https://doi.org/10.1007/s00398-016-0097-y

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