Myokardrevaskularisation bei reduzierter linksventrikulärer Funktion

Zusammenfassung

Die Myokardrevaskularisation bei hochgradig reduzierter linksventrikulärer Funktion stellt im klinischen Alltag eine besondere Herausforderung dar. Die hohe Sterblichkeit dieser Patienten konnte in den letzten Jahrzehnten im Wesentlichen durch die effektive Herzinsuffizienzmedikation gesenkt werden. Unzweifelhaft haben Revaskularisationsmaßnahmen bei ischämischer Genese einen hohen zusätzlichen Wert für die kardiovaskuläre Sterblichkeit und Morbidität der Patienten. Ob außerhalb von Akutsituationen eine Bypass-Operation oder eine perkutane Koronarintervention in Frage kommt, sollte anhand der Komorbiditäten des Patienten, der Koronarmorphologie und den Ergebnissen der Vitalitätstestung entschieden werden.

Abstract

Myocardial revascularization in patients with reduced left ventricular function remains a challenging clinical decision. The high mortality in these patients has been reduced by the routine use of guidelines-guided medical therapy for heart failure. However, myocardial revascularization additionally reduces cardiovascular mortality and improves functional outcome. Whether percutaneous coronary intervention or bypass surgery is indicated, should be decided individually with respect to comorbidities, morphology of the coronary vessels and the results of viability testing.

Schlüsselwörter

Myokardrevaskularisation - reduzierte linksventrikuläre Funktion - Herzinsuffizienz - koronare Herzerkrankung - Bypass-Operation - perkutane Koronarintervention

Keywords

Myocardial revascularization - reduced left ventricular function - heart failure - coronary artery disease - CABG - PCI

• Literatur

• 1 Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart 2007; 93: 1137-1146
• 2 McMurray JJ, Adamopoulos S, Anker SD et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the european society of cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 33: 1787-1847
• 3 Jhund PS, Macintyre K, Simpson CR et al. Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003: a population study of 5. 1 million people. Circulation 2009; 119: 515-523
• 4 Authors / Task Force members, Windecker S, Kohl P. 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
• 5 Velazquez EJ, Lee KL, Deja MA et al. Coronary-artery bypass surgery in patients with left ventricular dysfunction. The New England journal of medicine 2011; 364 (17) 1607-1616
• 6 Mark DB, Knight JD, Velazquez EJ et al. Quality-of-life outcomes with coronary artery bypass graft surgery in ischemic left ventricular dysfunction: a randomized trial. Ann Intern Med 2014; 161: 392-399
• 7 Velazquez EJ, Bonow RO. Revascularization in severe left ventricular dysfunction. J Am Coll Cardiol 2015; 65: 615-624
• 8 Di Sciascio G, Patti G, D’Ambrosio A et al. Coronary stenting in patients with depressed left ventricular function: acute and long-term results in a selected population. Catheter Cardiovasc Interv. 2003; 59: 429-433.
• 9 Sedlis SP, Morrison DA, Lorin JD et al. Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry. J Am Coll Cardiol. 2002; 40: 1555-1566
• 10 Hellhammer K, Balzer J, Zeus T et al. Percutaneous mitral valve repair using the MitraClip^® system in patients with anemia. Int J Cardiol 2015; 184: 399-404
• 11 Hellhammer K, Zeus T, Balzer J et al. Safety and efficacy of percutaneous mitral valve repair using the MitraClip^® system in patients with diabetes mellitus. PloS one 2014; 9: e111178
• 12 Bijuklic K, Schwencke C, Schofer J. Recanalization of chronic total coronary occlusions – high success rate despite a restrictive use of the retrograde approach. Catheterization and cardiovascular interventions. Catheter Cardiovasc Interv 2015;
• 13 Goktekin O, Yamac AH, Latib A et al. Evaluation of the safety of everolimus-eluting bioresorbable vascular scaffold (BVS) implantation in patients with chronic total coronary occlusions: Acute procedural and short-term clinical results. J Invasive Cardiol 2015; 27: 461-466