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Kathetergestützter Aortenklappenersatz: eine neue therapeutische Option der Aortenklappenstenose?

Transcatheter aortic valve replacement: when should it be used in aortic stenosis?

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Zusammenfassung

30 % aller Patienten mit einer signifikanten Aortenstenose werden aufgrund eines hohen Operationsrisikos nicht mit einem konservativen Aortenklappenersatz behandelt. Eine minimalinvasive Alternative für diese Patienten bietet der kathetergestützte Aortenklappenersatz (transcatheter aortic valve replacement; TAVI). Man unterscheidet bei den minimalinvasiven Verfahren grundsätzlich den transfemoralen und den transapikalen Aortenklappenersatz. Bei ersterem werden die auf einen Stentrahmen aufgebrachten Klappen kathetergesteuert über die Femoralgefäße implantiert. Der Zugangsweg für zweiteren ist eine linksanterolaterale Mini-Thorakotomie im fünften Interkostalraum. Die häufigsten Komplikationen sind Gefäß- und Blutungskomplikationen, ein neu aufgetretener höhergradiger AV-Block, die Entwicklung einer paravalvulären Insuffizienz, ein akutes Nierenversagen, ein Schlaganfall sowie eine TIA. Erste Studien in einem Hochrisikokollektiv zeigen gute Ergebnisse. Damit bietet die TAVI Hochrisikopatienten eine sinnvolle Therapie. Weitere Studien zum Langzeitverlauf der Patienten stehen noch aus.

Summary

30% of patients with significant aortic stenosis are not considered for operative aortic valve replacement because of the high perioperative risk. An alternative catheter based option for these patients is the transcatheter aortic valve replacement (TAVI). In general, there are two approaches for TAVI: transfemoral and transapical. Transfemoral aortic valve replacement is performed by transcatheter replacement of an aortic valve via the femoral arteries. Transapical valve replacement is achieved by transcatheter implantation via the fifth intercostal space. The most common complications are vessel injuries, bleeding complications, new onset of AV-block, development of paravalvular insufficiency, acute kidney injury, stroke and TIA. The first long-term observations suggest positive results. First clinical trials in a high-risk population show a promising outcome. Therefore TAVI offers a reasonable therapy option for patients with high perioperative risk. Further long-term clinical trials are still pending.

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Die Abbildungen 1–5 wurden freundlicherweise von den Firmen Edwards Lifesciences und Medtronic zur Verfügung gestellt, welche entsprechend das Copyright halten. L. J. M., S. R., D. R., M. H. und U. C. H. geben an, dass kein Interessenkonflikt besteht.

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  1. Universitätsklinik für Innere Medizin II, Paracelsus Medizinische Privatuniversität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich

    Lukas Jaroslaw Motloch, Sara Reda, Dennis Rottlaender, Matthias Heigert & Uta C. Hoppe

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  1. Lukas Jaroslaw Motloch
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Correspondence to Lukas Jaroslaw Motloch.

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Motloch, L., Reda, S., Rottlaender, D. et al. Kathetergestützter Aortenklappenersatz: eine neue therapeutische Option der Aortenklappenstenose?. Wien Med Wochenschr 162, 340–348 (2012). https://doi.org/10.1007/s10354-012-0136-6

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