Eine engmaschige Nachbeobachtung von Patienten mit kathetergestütztem Aortenklappenersatz
(TAVI) kann Komplikationen verhindern, die häufig durch Komorbiditäten ausgelöst werden.
Im Folgenden sollen neben Empfehlungen zu klinischen, laborchemischen, elektro- und
echokardiografischen Verlaufskontrollen auch die Endokarditis-Prophylaxe beleuchtet
werden. Zentraler Aspekt im postinterventionellen TAVI-Management ist außerdem das
antithrombotische Regime, das hier schwerpunktmäßig erläutert werden soll.
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard therapy
for patients with severe aortic stenosis with a high operative risk or older than
75 years. As these patients usually exhibit several comorbidities, not only the preinterventional
and periinterventional management are of interest, but also the postinterventional
care plays an incremental role in order to prevent short and long term complications
having an enormous influence on morbidity and mortality. Therefore, a close clinical
observation by the primary care physician and primary cardiologist is essential for
the patient’s outcome. After discharge the first follow up examination should be carried
out 1 to 3 months after TAVI, the second one 6 months after TAVI, afterwards once
a year. A detailed anamnesis especially regarding symptoms such as dyspnoea, anginal
complaints and vertigo should be performed. Additionally, an electrocardiogram is
recommended to detect conduction disturbances. An echocardiography with the focus
on prosthetic valve function, paravalvular leckage, left ventricular function and
possible indications for endocarditis is essential. Next to the endocarditis prophylaxis
before specific dental procedures, the antithrombotic regimen plays a key role in
the follow up management after TAVI. On the one hand, antithrombotic therapy reduces
thromboembolic complications, on the other hand they might increase the bleeding risk.
An optimal antithrombotic treatment strategy challenges clinicians as patient-specific
risk factors and comorbidities (e. g., age, atrial fibrillation, coronary artery disease)
must be considered and current data still leave some uncertainties.
Schlüsselwörter
TAVI - Nachsorge - antithrombotische Therapie
Key words
TAVI - follow up - antithrombotic therapy
