Aortenklappenoperationen bei jungen Erwachsenen

Zusammenfassung

Junge Erwachsene, die sich einer Aortenklappenoperation unterziehen müssen, werden oft eine (relative) Kontraindikation gegen eine orale Antikoagulation aufweisen, weil entweder ein Schwangerschaftswunsch besteht oder ein sehr aktiver Lebensstil geführt wird. Dieser Übersichtsartikel zeigt die chirurgischen Optionen auf, die in solchen Fällen bestehen, und bewertet die zur Verfügung stehende Literatur bezüglich der Frage, welche Erfahrungen für die einzelnen Techniken speziell mit jungen Leuten besteht.

Es liegen keine randomisierten Studien vor, die den mechanischen Herzklappenersatz mit alternativen Verfahren in Bezug auf Überleben, Reoperationshäufigkeit und Lebensqualität in dieser Altersgruppe vergleichen. Als alternative Verfahren erscheinen v. a. die Ross-Operation (pulmonaler Autograft) und die Aortenklappenrekonstruktion attraktiv. Insb. mit der Ross-Operation besteht eine relativ große Erfahrung auch in der Behandlung von jungen Erwachsenen. Bis zu 10 Jahre postoperativ sind die Ergebnisse sehr gut, darüber hinaus besteht bislang leider kaum Erfahrung.

Summary

Young adults who have to undergo aortic valve surgery will frequently have (relative) contraindications to oral anticoagulation therapy because either pregnacy is planned or their life-style is very active. This review focuses on the surgical options available and assesses the literature focusing on the experience with each option obtained in young adults.

There are no randomized studies in this age group which compare mechanical aortic valve replacement with any alternative option with regard to survival, need for reoperation, or quality of life. Among the alternative techniques, the Ross-procedure (pulmonary autograft) and aortic valve repair are of special interest. With the Ross-procedure, there is a rather large experience in young adults, and the results up to 10 years postoperatively are excellent. Unfortunately, there is only limited experience with this technique beyond that time.

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