Heart valve surgery today: indications, operative technique, and selected aspects of postoperative care in acquired valvular heart disease

• Published in: Deutsches Ärzteblatt international Vol. 106; no. 13; pp. 224 - 33; quiz 234
• Main Authors: Geissler, Hans Joachim, Schlensak, Christian, Südkamp, Michael, Beyersdorf, Friedhelm
• Format: Journal Article
• Language: English
• Published: Germany Deutscher Arzte Verlag 01.03.2009
• Subjects: Continuing Medical Education; Germany - epidemiology; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Incidence; Postoperative Care - statistics & numerical data; Germany; cardiac surgery; valvular heart disease; endocarditis; cardiac valve reconstruction; cardiac valve replacement
• ISSN: 1866-0452
• DOI: 10.3238/arztebl.2009.0224

Surgery plays a central role in the management of acquired valvular heart disease. The optimal diagnostic evaluation, surgical treatment, and postoperative care of these patients are only possible through a cooperative effort of the primary care physician, the cardiologist, and the cardiac surgeon. The literature was selectively searched for information on surgical indications, operative techniques, and postoperative care in acquired valvular heart disease. Evidence-based guidelines and treatment recommendations were also taken into account. A wide variety of techniques and implants are now available for the surgical treatment of acquired valvular heart disease. If they are used in evidence-based fashion, the perioperative mortality is low and the long-term outcome is favorable. The volume of surgery for acquired valvular heart disease in Germany has increased substantially in recent years, from 25,495 cases in 2002 (corresponding to 26.5% of all heart operations in that year) to 33,412 in 2007 (36.5% of all heart operations). The causes for this include both demographic changes and the availability of new, less invasive surgical techniques that yield better results in elderly and/or multimorbid patients. Because of these new techniques, the indications for surgery have widened, while the results have remained favorable.