Aortenklappenersatz mit nahtfreien Herzklappenprothesen – aktueller Stand und Stellenwert in der Zukunft

Zusammenfassung

Im Rahmen des chirurgischen Aortenklappenersatzes führt der kontinuierliche Anstieg der durchschnittlichen Lebenserwartung unserer Bevölkerung sowie die damit verbundene Zunahme von Komorbiditäten zu einer immer häufigeren Verwendung biologischer Prothesen, auch um eine dauerhafte Antikoagulation zu vermeiden. Eine neue Alternative für den AKE stellt der Einsatz von nahtfreien, sog. Sutureless-Prothesen dar. Dabei handelt es sich um eine biologische, in einem Stent fixierte Perikardprothese, welche – wie der Name schon sagt – ohne bzw. nur mit wenigen Nähten chirurgisch implantiert wird. Zurzeit sind 3 Sutureless-Modelle auf dem Markt verfügbar, die eine beträchtliche Vereinfachung und Verkürzung der Implantation ermöglichen. Dies kann besonders für jene Patienten von Vorteil sein, welche ein erhöhtes Risiko aufweisen oder sich einer komplizierten Operation unterziehen müssen.

Abstract

In recent years, the prevalence of high-risk patients undergoing surgical aortic valve replacement has increased. To modify the risk associated with duration of cross clamp time or cardioplegic ischemic time, sutureless aortic prostheses have been developed. As indicated by the name, sutureless aortic bioprosthetic valves are not hand-sewn but self-anchoring. This technological modification, resulting in a reduced implantation time, could improve the outcome of patients referred for aortic valve replacement. Three sutureless bioprostheses are available on the market: 3f Enable (Medtronic Inc., Minneapolis, Minnesota, USA), Perceval S (Sorin Group, Saluggia, Italy) and Intuity (Edwards Lifesciences, Irvine, California, USA). This article provides an overview of the characteristics and of the published literature for those implants with an attempt to better define the role of sutureless valves in the treatment for the aortic valve stenosis and their future perspectives.

Schlüsselwörter

symptomatische Aortenklappenstenose - Aortenklappenersatz - biologische Prothesen - nahtfreie Aortenklappenprothesen

Key words

aortic valve stenosis - aortic valve replacement - biological prostheses - sutureless aortic valve prostheses

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