Perkutane Aortenklappenimplantation (TAVI) zur Behandlung schwerer symptomatischer Aortenklappenstenosen: aktueller Stand

Zusammenfassung

Die perkutane kathetertechnische Aortenklappenimplantation (TAVI) hat sich als eine Alternative zum chirurgischen Aortenklappenersatz bei chirurgischen Hoch-Risikopatienten und als Mittel der Wahl der Behandlung inoperabler Patienten mit schwerer symptomatischer Aortenstenose etabliert. Bereits jetzt werden mehr als ein Drittel aller Aorten-Klappenersatztherapien in Deutschland als TAVI durchgeführt. Elementar wichtig ist die geeignete Auswahl der Patienten als auch der Interventionsart. Dies sollte durch ein sogenanntes „Herz-Team“, bestehend zumindest aus einem Kardiologen und einem Herzchirurgen, erfolgen.

Abstract

Percutaneous trans-catheter aortic valve implantation (TAVI) has been established as an alternative to surgical valve replacement in surgical high-risk patients. TAVI is also considered the treatment of choice for symptomatic with severe aortic stenosis who are judged to be in-operable. In current practice in Germany more than one third of all aortic valve replacement interventions are performed as a TAVI procedure. It is of crucial importance that proper selection of patients as well as the treatment modality is performed by a so called „heart team“, consisting of at least a cardiologist and a cardiac surgeon.

Schlüsselwörter

Aortenstenose - perkutaner Aortenklappenersatz - TAVI - chirurgischer Aortenklappenersatz

Keywords

aortic stenosis - transcatheter aortic valve implantation - TAVI - surgical aortic valve implantation

• Literatur

• 1 AQUA-Qualitätsreport 2010. Aortenklappenchirurgie isoliert (konventionell/kathetergestützt). 2012. http://www.sqg.de/themen/qualitaetsreport/qualitaetsreport-2010/index.html
• 2 Abdel-Wahab M, Zahn R, Horack M et al. Aortic regurgitation after transcatheter aortic valve implantation: incidence and early outcome. Results from the German transcatheter aortic valve interventions registry. Heart 2011; 97: 899-906
• 3 Aronow WS, Ahn C, Kronzon I et al. Prognosis of congestive heart failure in patients aged > or = 62 years with unoperated severe valvular aortic stenosis. Am J Cardiol 1993; 72: 846-848
• 4 Beckmann A, Hamm C, Figulla HR et al. The German Aortic Valve Registry (GARY): A nationwide registry for patients undergoing invasive therapy for severe aortic valve stenosis. Thorac Cardiovasc Surg 2012; 60: 319-325
• 5 Bleiziffer S, Mazzitelli D, Nobauer C et al. Successful treatment of pure aortic insufficiency with transapical implantation of the JenaValve. Thorac Cardiovasc Surg 2013; (online)
• 6 Cribier A, Eltchaninoff H, Bash A et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 2002; 106: 3006-3008
• 7 Dvir D, Lavi I, Kornowski R. Transcatheter aortic valve implantation of a CoreValve device using novel real-time imaging guidance. Cardiovasc Revasc Med 2013; 14: 49-52
• 8 Dvir D, Webb J, Brecker S et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the Global Valve-in-Valve Registry. Circulation 2012; 126: 2335-2344
• 9 Figulla HR, Cremer J, Walther T et al. Positionspapier zur kathetergeführten Aortenklappenintervention. Kardiologe 2009; 3: 199-206
• 10 Grube E, Laborde JC, Gerckens U et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: the Siegburg first-in-man study. Circulation 2006; 114: 1616-1624
• 11 Grube E, Schuler G, Buellesfeld L et al. Percutaneous aortic valve replacement for severe aortic stenosis in high-risk patients using the second- and current third-generation self-expanding CoreValve prosthesis: device success and 30-day clinical outcome. J Am Coll Cardiol 2007; 50: 69-76
• 12 Hamm CW, Albrecht A, Bonzel T et al. Diagnostische Herzkatheteruntersuchung. Clin Res Cardiol 2008; 97: 475-512
• 13 Iung B, Cachier A, Baron G et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J 2005; 26: 2714-2720
• 14 Kodali SK, Williams MR, Smith CR et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med 2012; 366: 1686-1695
• 15 Leon MB, Smith CR, Mack M et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363: 1597-1607
• 16 Makkar RR, Fontana GP, Jilaihawi H et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 2012; 366: 1696-1704
• 17 Mudra H, Sack S, Haude M et al. Strukturelle und organisatorische Voraussetzungen zur Duchführung des Transkatheter-Aortenklappenersatzes (TAVI). Kardiologe 2011; 5: 366-371
• 18 Rosengart TK, Feldman T, Borger MA et al. Percutaneous and minimally invasive valve procedures: a scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2008; 117: 1750-1767
• 19 Smith CR, Leon MB, Mack MJ et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364: 2187-2198
• 20 Treede H, Thilo T, Reichenspurner H et al. Six-month results of a repositionable and retrievable pericardial valve for transcatheter aortic valve replacement: The Direct Flow Medical aortic valve. J Thorac Cardiovasc Surg 2010;
• 21 Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012; 33: 2451-2496
• 22 Vahanian A, Baumgartner H, Bax J et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28: 230-268
• 23 Webb JG, Pasupati S, Humphries K et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation 2007; 116: 755-763
• 24 Zahn R, Gerckens U, Grube E et al. Transcatheter aortic valve implantation: first results from a multi-centre real-world registry. Eur Heart J 2011; 32: 198-204