Operative Strategien bei Typ-A-Dissektion
Zusammenfassung Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum. Primäres Ziel stellt das Überleben des Patienten dar. Hierauf basierend sollten prä- und intraoperative Entscheidungen in Bezug auf die Komplex...
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Published in | Zeitschrift für Herz-, Thorax- und Gefässchirurgie Vol. 29; no. 3; pp. 159 - 174 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | German |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.06.2015
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Abstract | Zusammenfassung
Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum. Primäres Ziel stellt das Überleben des Patienten dar. Hierauf basierend sollten prä- und intraoperative Entscheidungen in Bezug auf die Komplexität des Eingriffs getroffen werden. Dennoch erlauben bessere technische Möglichkeiten und zunehmende Expertise in der Behandlung auch komplexer Aortenerkrankungen heute bereits aggressivere Strategien mit Hinblick auf die Optimierung der Langzeitprognose. Ob in Zukunft der komplette Aortenbogenersatz mit Hybridprothese die Therapie der Wahl darstellen wird, bleibt zu beweisen. Gleiches gilt für aufwendige rekonstruktive Verfahren an der Aortenwurzel. Da Reeingriffe an der Aortenwurzel komplikationsträchtiger sind als am Aortenbogen, sollte aber der Aortenwurzel grundsätzlich der Vorzug gegenüber der Aorta descendens im Entscheidungsprozess um das haltbarere Verfahren gegeben werden. Umgekehrt könnte in Zukunft auch eine endovaskuläre Versorgung bei ausgesuchten Patienten im fortgeschrittenen Alter einen Stellenwert erlangen. |
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AbstractList | Zusammenfassung
Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum. Primäres Ziel stellt das Überleben des Patienten dar. Hierauf basierend sollten prä- und intraoperative Entscheidungen in Bezug auf die Komplexität des Eingriffs getroffen werden. Dennoch erlauben bessere technische Möglichkeiten und zunehmende Expertise in der Behandlung auch komplexer Aortenerkrankungen heute bereits aggressivere Strategien mit Hinblick auf die Optimierung der Langzeitprognose. Ob in Zukunft der komplette Aortenbogenersatz mit Hybridprothese die Therapie der Wahl darstellen wird, bleibt zu beweisen. Gleiches gilt für aufwendige rekonstruktive Verfahren an der Aortenwurzel. Da Reeingriffe an der Aortenwurzel komplikationsträchtiger sind als am Aortenbogen, sollte aber der Aortenwurzel grundsätzlich der Vorzug gegenüber der Aorta descendens im Entscheidungsprozess um das haltbarere Verfahren gegeben werden. Umgekehrt könnte in Zukunft auch eine endovaskuläre Versorgung bei ausgesuchten Patienten im fortgeschrittenen Alter einen Stellenwert erlangen. Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum. Primäres Ziel stellt das Überleben des Patienten dar. Hierauf basierend sollten prä- und intraoperative Entscheidungen in Bezug auf die Komplexität des Eingriffs getroffen werden. Dennoch erlauben bessere technische Möglichkeiten und zunehmende Expertise in der Behandlung auch komplexer Aortenerkrankungen heute bereits aggressivere Strategien mit Hinblick auf die Optimierung der Langzeitprognose. Ob in Zukunft der komplette Aortenbogenersatz mit Hybridprothese die Therapie der Wahl darstellen wird, bleibt zu beweisen. Gleiches gilt für aufwendige rekonstruktive Verfahren an der Aortenwurzel. Da Reeingriffe an der Aortenwurzel komplikationsträchtiger sind als am Aortenbogen, sollte aber der Aortenwurzel grundsätzlich der Vorzug gegenüber der Aorta descendens im Entscheidungsprozess um das haltbarere Verfahren gegeben werden. Umgekehrt könnte in Zukunft auch eine endovaskuläre Versorgung bei ausgesuchten Patienten im fortgeschrittenen Alter einen Stellenwert erlangen. |
Author | Pichlmaier, M. Reichelt, A. Hoffmann, A.-L. Günther, S. Peterß, S. Hagl, C. |
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Cites_doi | 10.1016/j.ejcts.2010.03.070 10.1093/ejcts/ezs025 10.1016/j.athoracsur.2005.11.038 10.1016/j.ejcts.2008.02.030 10.1093/ejcts/ezu185 10.1016/j.ejcts.2008.05.014 10.1016/j.jtcvs.2006.09.059 10.1055/s-0029-1240979 10.1093/ejcts/ezs296 10.1161/CIR.0b013e3181d4739e 10.1016/j.jtcvs.2014.06.095 10.1016/j.athoracsur.2009.06.055 10.1016/j.jtcvs.2014.05.027 10.1093/icvts/ivu323 10.1093/ejcts/ezt359 10.1093/ejcts/ezu284 10.1016/j.jtcvs.2011.08.052 10.1016/j.ejcts.2008.05.038 10.1093/ejcts/ezt229 10.1016/j.jtcvs.2006.04.016 10.1016/j.jtcvs.2006.07.043 10.1056/NEJMe1412950 10.1007/978-3-319-09555-4_5 |
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Keywords | Perfusion Kanülierung Circulatory arrest Aortic dissection Cannulation Aortendissektion Extrakorporaler Kreislauf Kreislaufstillstand Extracorporeal circulation |
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Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum.... Die akute Typ-A-Dissektion bedarf nach Ansicht der Autoren der sofortigen operativen Behandlung in einem herzchirurgisch versierten Zentrum. Primäres Ziel... |
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SubjectTerms | Aortic dissection Cardiac Surgery CME Coronary vessels Medicine Medicine & Public Health Thoracic Surgery Vascular Surgery |
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Title | Operative Strategien bei Typ-A-Dissektion |
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