Erkrankungen der Aorta: von der Aortenklappe bis zur Aortenbifurkation

Was ist neu?

Stand der Dinge Sowohl im klinischen Bereich als auch in der Forschung etabliert sich zunehmend das Konzept, die Aorta als Gesamtorgan zu betrachten, das sich von der Aortenklappe bis zur Bifurkation erstreckt.

Aortenklappenstenose Aktuell laufen erste randomisierte Studien zur Ausweitung der Indikation zum interventionellen Aortenklappenersatz (TAVI, TAVR) hin zu einem Patientenkollektiv mit niedrigem OP-Risiko. Des Weiteren hat die interventionelle Versorgung der „Low flow, low gradient“-Aortenklappenstenose eine Aufwertung im Empfehlungsgrad erhalten und die interventionelle Valve-in-valve-Prozedur Eingang in den klinischen Alltag bei der individualisierten Patientenversorgung gefunden.

Aortenklappeninsuffizienz Kathetergestützt implantierte Klappenprothesen, die dediziert zur Behandlung der isolierten Aortenklappeninsuffizienz entwickelt werden, befinden sich für dieses Krankheitsbild in der klinischen Prüfung.

Erkrankungen der Aorta ascendens und descendens Während das Screening von Aortenaneurysmen zur ambulanten Routine wird, sind Studien zum risikostratifizierten Follow-up bei zunehmend endovaskulär versorgten Patienten notwendig, um eine bedarfsgerechte Nachsorge zu ermöglichen.

Abstract

There is growing understanding to recognize the aorta as complex system and treat aortic diseases in an integrated fashion.

The indication for interventional aortic valve replacement (TAVR) comprises patients with moderate and high perioperative risk and symptomatic, high grade aortic valve stenosis. In contrast „low risk“ patients receive conventional therapy. Ongoing randomised trials analyse the expansion of indication towards low risk patients for interventional approaches. A final rating is owing, but first data support the assumption that both therapeutic options may be equivalent. Moreover, the interventional therapy of low flow, low gradient aortic valve stenosis has been revalued and interventional valve-in-valve therapy has been integrated into clinical routine as invidualised decision of the heart team.

Aortic diseases include several entities which require specialised diagnostic and therapeutic tools. Studies to evaluate evidence of follow up options need to be performed in future to enable for surveillance tailored to suit medical need.

Schlüsselwörter

TAVI - Aortenklappenstenose - Aortenaneurysma - endovaskuläre Therapie - Follow-up

Key words

TAVR - aortic stenosis - aortic aneurysm - endovascular repair - follow up

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