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Herzchirurgie

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Anästhesiologie

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Zusammenfassung

Seit Gibbon [85] im Jahre 1953 die erste erfolgreiche Herzoperation (Verschluß eines Vorhofseptumdefekts) mit Hilfe der Herz-Lungen-Maschine durchführte, hat sich die Chirurgie am offenen Herzen einerseits zu einem Routineverfahren entwickelt, das, zumindest was die Herzchirugie beim Erwachsenen betrifft, nicht mehr universitären Zentren vorbehalten ist. Andererseits hat die zunehmende Erfahrung und sinkende Operationsmortalität es ermöglicht, die Indikationen für herzchirurgische Eingriffe auf Hochrisikopatienten und höhere Altersklassen auszudehnen und neue Operationsverfahren, z.B. die Herztransplantation und Eingriffe am kardialen Reizleitungssystem sowie die primäre Totalkorrektur komplexer angeborener Herzfehler im frühen Säuglings- oder Neugeborenenalter, einzuführen. Verschiedene Faktoren haben zu dieser Entwicklung beigetragen:

  • Fortschritte im Bereich myokardprotektiver Maßnahmen (Einsatz kardioplegischer Lösungen) und das bessere Verständnis der Reperfusionsvorgänge nach temporärer Myokardischämie;

  • Neuerungen der extrakorporalen Zirkulations-(EKZ-) Technik, v. a. die geringere Bluttraumatisierung durch Verwendung blutfreier Perfusionslösungen (Hämodilution), die Reduktion des Füllvolumens der Herz-Lungen-Maschine (HLM) und der Einsatz von Membranoxygenatoren;

  • Fortschritte der chirurgischen Technik, Verbesserung von Klappenprothesen und Graftmaterial, Entwicklung von Systemen zur apparativen Kreislaufunterstützung (intraaortale Ballongegenpulsation, ventrikuläre Assistoren);

  • bessere Kenntnisse der spezifischen Herz-Kreis-lauf-Wirkungen von Anästhetika und Analgetika durch systematische klinisch-experimentelle Untersuchungen und entsprechende Adaptation der Anästhesieverfahren. Neuerungen in der perioperativen Überwachungstechnik (Pulmonaliskatheter, kontinuierliche pulmonalarterielle Oxymetrie, ST-Segmentanalyse, transösophageale Echokardiographie);

  • besseres Verständnis der Pathophysiologie des akuten Herz-Kreislauf-Versagens und die Einführung differenzierterer Konzepte zur pharmakologischen Kreislaufunterstützung.

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Authors
  1. E. R. Schmid
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  2. R. Gattiker
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Editors and Affiliations

  1. Institut für experimentelle Anästhesiologie, Ludwig-Maximilians-Universität, Bereich Poliklinik, Pettenkoferstr. 8 a, D-80336, München, Deutschland

    Alfred Doenicke

  2. Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Universität Göttingen, Robert-Koch-Str. 40, D-37070, Göttingen, Deutschland

    Dietrich Kettler

  3. Universitätsklinik für Anästhesiologie, LKH Graz, Auenbruggerplatz, A-8036, Graz, Österreich

    Werner F. List

  4. Klinik für Anästhesiologie und Operative Intensivmedizin, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, D-06097, Halle (Saale), Deutschland

    Joachim Radke

  5. Institut für klinische Anästhesiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, D-40001, Düsseldorf, Deutschland

    Jörg Tarnow

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© 1995 Springer-Verlag Berlin Heidelberg

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Schmid, E.R., Gattiker, R. (1995). Herzchirurgie. In: Doenicke, A., Kettler, D., List, W.F., Radke, J., Tarnow, J. (eds) Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-97553-0_23

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  • DOI: https://doi.org/10.1007/978-3-642-97553-0_23

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-97554-7

  • Online ISBN: 978-3-642-97553-0

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