Zusammenfassung
Die Zahl älterer Patienten mit Aortenklappenstenose und multiplen Begleiterkrankungen wird aufgrund der demografischen Entwicklung drastisch zunehmen. Während insbesondere bei vielen jüngeren Patienten der konventionell chirurgische Aortenklappenersatz aufgrund niedriger Komplikations- und hoher Erfolgsraten nach wie vor als Goldstandard angesehen werden muss, ist für die Gruppe der Hochrisikopatienten die kathetergestützte transfemorale oder transapikale Aortenklappenimplantation eine vorteilhafte Behandlungsalternative. Bei der Auswahl der Methode spielt das „Heart Team“ aus Kardiologe, Herzchirurg und Anästhesist eine wichtige Rolle. Voraussetzung für eine erfolgreiche kathetergestützte Klappenimplantation ist ein gutes Screening der Patienten mit differenzierter präinterventioneller Bildgebung. Die Ergebnisse der perkutanen Aortenklappenimplantation sind in den heute vorliegenden Studien als sehr vielversprechend anzusehen.
Abstract
Aortic valve stenosis (AS) is the most common acquired valve disease in the industrialized countries. Most patients—especially young and low-risk patients—can be safely and effectively operated with aortic valve replacement. Due to increasing life expectancy, however, the number of elderly patients with AS and various concomitant diseases will increase in the coming decades. For those elderly high-risk patients, transfemoral or transapical aortic valve implantation (TAVI) has evolved as a valuable alternative to conventional surgery. The TAVI approach has been shown to be superior to standard medical treatment in these high-risk patients. All patients considered for TAVI should be discussed in a consensus conference consisting of cardiac surgeons and cardiologists (heart team). Furthermore, for successful treatment with transcatheter techniques, sophisticated pre-interventional imaging is required to screen patients. Available data on TAVI from randomized trials and large-scale registries demonstrate that this method is very promising.
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Interessenkonflikt. H. Möllmann: Edwards Lifesciences, Medtronic, Abbott, Symetis. W.-K. Kim: Symetis. T. Walther und C. Hamm geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Möllmann, H., Kim, WK., Walther, T. et al. Transkatheteraortenklappenersatz (TAVI). Internist 54, 1469–1483 (2013). https://doi.org/10.1007/s00108-013-3382-9
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DOI: https://doi.org/10.1007/s00108-013-3382-9
Schlüsselwörter
- Aortenklappenstenose
- Transfemorale kathetergestützte Aortenklappenimplantation
- Transapikale kathetergestützte Aortenklappenimplantation
- Patientenauswahl
- Echokardiographie