Innovations in aortic valve surgery,Innovative Techniken in der modernen Aortenklappenchirurgie

The incidence of valvular heart disease has steadily increased over the past decades in western countries and is expected to continuously do so in the face of an aging population. Beginning in the 1990s, minimally invasive aortic valve procedures were developed, reducing surgical trauma, and resulting in improved patient outcome as documented in prospective randomized trials. Thus, the minimally invasive approach to aortic valve disease has become the standard of care at specialized centers. In patients with functional aortic valve disease, repair of the native valve should be attempted whenever possible. While minimally invasive aortic valve replacement (AVR) offers some advantages in terms of reduced invasiveness, the need for extracorporeal circulation remains and thereby excludes a substantial patient population from surgical treatment. Therefore, interventional transcatheterbased beating heart procedures have been developed. However, results of these new approaches always have to be matched with the superior outcomes of surgical AVR. At present, most clinicians involved agree that pAVR should be restricted to patients deemed inoperable due to comorbidities.