Koronarchirurgie in Off-Pump-Technik. Wer profitiert davon?

Zusammenfassung

Die Diskussion um die beste operative Strategie der koronaren Bypassoperation wird unter den Herzchirurgen sehr intensiv geführt. Vier prospektiv randomisierte Multicenterstudien der letzten 4 Jahre konnten keine wesentlichen Unterschiede zwischen den konkurrierenden OP-Verfahren feststellen. Demgegenüber weisen Metaanalysen und Datenbankauswertungen tendenziell einen Vorteil der Off-Pump-Koronarrevaskularisation hinsichtlich Mortalität, Schlaganfallrate, Nierenversagen und Nachblutung aus. Die erneute Revaskularisation ist nach On-Pump-Eingriffen seltener. Die Vermeidung einer notfallmäßigen Konversion zum HLM-Eingriff scheint für die erfolgreiche OPCAB-Prozedur entscheidend zu sein. Dafür sind Regelmäßigkeit und Erfahrung essenziell.

Abstract

There is an intensive discussion among cardiac surgeons regarding the best operative strategy for coronary surgery. Four prospective randomized multi-center trials did not detect any differences between the concurrent operative procedures. However, meta-analyses and the evaluation of databases detected an advantage of off-pump coronary revascularization regarding mortality and the incidences for stroke, renal failure and bleeding. The need for repeat revascularization was lower after on-pump procedures. The avoidance of emergent conversion to the on-pump procedure seems to be crucially. For that routine and experience are essential.

Schlüsselwörter

koronare Herzerkrankung - On-Pump-Koronarchirurgie - Off-Pump-Koronarchirurgie

Key words

coronary artery disease - on-pump coronary artery surgery - off-pump coronary artery surgery

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