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tienten mit einem mittleren Alter von über 75 Jahren sehr wohl von einer Rekonstruktion der Mitralklappe profitieren (26, 27, 28). Die Mitralklappenrekonstruktion war im Vergleich zum Mitralklappenersatz bei den über 70-jährigen Patienten mit weniger zerebrovaskulären Komplikationen (4,3 % vs. 21,3 %) und einer geringeren 30-Tage-Mortalität (7,1 % vs. 23,4 %) vergesellschaftet (26). In anderen Studien wurden für die Mitralklappenrekonstruktion gegenüber dem Klappenersatz perioperative Mortalitäten von 0,7 % vs. 12,5 % bzw. 14,3 % vs. 27 % berichtet (29–32). Die Reoperation wegen ineffektiver Re-

konstruktion ist auch bei alten Patienten in geübten Händen selten. Die höchste Mortalität haben alte Patienten, die wegen einer ischämischen Mitralklappeninsuffizienz operiert wurden. Auch hier könnten sich zukünftig katheterinterventionelle Techniken prognostisch günstig auswirken. Für alte Patienten mit Mitralklappeninsuffizienz gilt genauso wie für alte Patienten mit Aortenklappenstenose, dass bei gegebener Interventionsindikation diese nicht allein aufgrund des kalendarischen Lebensalters hinausgezögert oder gar verweigert werden sollte.

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