Mitralklappe: wann konservativ, wann operativ, wann interventionell?

Die Therapie der hochgradigen symptomatischen Mitral-Insuffizienz ist aufgrund der äußerst komplexen Mitralklappen-Anatomie herausfordernd. Neben dem langjährig etablierten M-TEER-Verfahren und der Katheter-technischen Anuloplastie gibt es Entwicklungen im Bereich des interventionellen Mitralklappen-Ersatzes (TMVR). Dieser Artikel gibt eine Übersicht der aktuellen Therapieempfehlungen und der zur Verfügung stehenden Therapieverfahren.

Abstract

The management of severe symptomatic mitral regurgitation is in contrast to the aortic-valve-intervention more challenging due to the complex mitral-valve anatomy. In primary mitral regurgitation surgical therapy is recommended, whereas there are various therapeutic options in secondary mitral regurgitation. Besides the established mitral-valve Transcatheter Edge-to-Edge-Repair (M-TEER) and the interventional annuloplasty – devices dynamic developments have recently been made in the field of Transcatheter Mitral Valve Replacement-therapy (TMVR). This article surveys the current recommendations and available therapeutic options in mitral regurgitation.

Schlüsselwörter

Mitral-Insuffizienz - M-TEER - Mitralklappen-Rekonstruktion

Key words

mitral regurgitation - M-TEER - mitral valve reconstruction

Publication History

Article published online:
15 August 2022

• Literatur

• 1 Verma S, Latter DA, Bonow RO. Failed mitral TEE-R – Are there lessons for decision making?. J Am Coll Cardiol 2021; 78 (01) 10-13
• 2 Koeell B, Kalbacher D, Lubos E. Current devices and interventions in mitral regurgitation. Herz 2021; 46: 419-428
• 3 Dziadzko V, Clavel MA, Dziadzko M. et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet 2018; 391: 960-969
• 4 Vahanian A, Beyersdorf F, Praz F. et al. ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2022; 43 (07) 561-632
• 5 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines. Circulation 2021; 143: e72-e227
• 6 Mirabel M, Iung B, Baron G. et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?. Eur Heart J 2007; 28: 1358-1365
• 7 Baldus S, von Bardeleben RS, Eggebrecht H. et al. Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren. Kardiologe 2020; 14: 339-363
• 8 Carpentier A. Cardiac valve-surgery – the “French correction”. J Thorac Cardiovasc Surg 1983; 86 (03) 323-337
• 9 Lazam S, Vanoverschelde JL, Tribouilloy C. et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large prospective registry. Circulation 2017; 135 (05) 410-422
• 10 Alfieri O, Maisano F, Bonis MD. et al. The double-orifice technique in mitral valve repair: a simple solution for complex problems. J Thorac Cardiovasc Surg 2001; 122: 674-681
• 11 Szerlip M, Spargias KS, Makkar R. et al. 2 year outcomes for transcatheter repair in patients with mitral regurgitation from the CLASP study. JACC Cardiovasc Interv 2021; 14 (14) 1538-1548
• 12 Stone GW, Lindenfeld J, Abraham WT. et al. (COAPT Investigators). Transcatheter Mitral Valve Repair in patients with heart failure. N Engl J Med 2018; 379 (24) 2307-2318
• 13 Obadia JF, Messika-Zeitoun D, Leurent G. et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018; 379: 2297-2306
• 14 Orban M, Karam N, Lubos E. Impact of proportionality of secondary mitral regurgitation on outcome after transcatheter mitral valve repair. JACC Cardiovasc Imaging 2021; 14 (04) 715-725
• 15 Messika-Zeitoun D, Nickenig G, Latib A. et al. Transcatheter mitral valve repair for functional mitral regurgitation using the cardioband system: 1 year outcomes. Eur Heart J 2018; 40: 466-472
• 16 Patterson T, Adams H, Allen C. et al. Indirect annuloplasty to treat functional mitral regurgitation: current results and future perspectives. Front Cardiovasc Med 2019; 6: 60
• 17 Witte KK, Lipiecki J, Siminiak T. et al. The REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail 2019; 7: 945-955
• 18 Siminiak T, Hoppe UC, Haude M. et al. Treatment of functional mitral regurgitation by percutaneous anuloplasty: results of the TITAN trial. Eur Heart J 2012; 14: 931-938
• 19 Colli A, Manzan E, Aidietis A. et al. An early European experience with transapical off-pump mitral valve repair with NeoChord implantation. Eur J Cardiothorac Surg 2018; 54: 460-466
• 20 Sorajja P, Moat N, Badhwar V. et al. Initial feasibility study of a new transcatheter mitral prosthesis the first 100 patients. J Am Coll Cardiol 2019; 73: 1250-1260
• 21 Demir OM, Bolland M, Curio J. et al. Transcatheter mitral valve replacement: current evidence and concepts. Interv Cardiol 2021; 16: e7
• 22 Blanke P, Naoum C, Dvir D. et al. Predicting LVOT obstruction in transcatheter mitral valve implantation concept of the Neo-LVOT. JACC Cardiovasc Imaging 2017; 10: 482-485
• 23 Weber M, Vogelhuber J, Öztürk C. et al. Perspectives on transcatherer mitral therapy – Comparing devices and methods fort he treatment of mitral valve regurgitation. Cardiac Interventions 2021; 5 (03) 44-49
• 24 Ali WB, Ludwig S, Duncan A. et al. Characteristics and Outcomes of Patients Screened for Transcatheter Mitral Valve Implantation: 1-Year Results from the CHOICE-MI Registry. Eur J Heart Fail 2022; 24 (05) 887-898