TAVI: Ist das Verfahren eine Alternative bei Patienten ohne erhöhtes Operationsrisiko?

Zusammenfassung

Die kathetergestützte Aortenklappenimplantation (TAVI) hat sich als sichere und effektive Prozedur zur Behandlung der hochgradigen symptomatischen Aortenklappenstenose etabliert und wird mittlerweile auch bei Patienten niedrigen und intermediären Risikos eingesetzt. Die verfügbaren Studien hierzu umfassen mittlerweile mehr als 9000 Patienten mit sehr vielversprechenden Ergebnissen für das kathetergestützte Verfahren im Vergleich mit dem operativen Aortenklappenersatz. Inwieweit sich diese Ergebnisse auch über einen langfristigen Nachbeobachtungszeitraum bestätigen, bleibt derzeit noch abzuwarten. Auch darüber hinaus wird das interdisziplinäre Herzteam integraler Bestandteil der Indikationsstellung und Therapieplanung bleiben.

Abstract

Transcatheter aortic valve implantation (TAVI) has evolved as a safe and effective treatment option for patients with severe symptomatic aortic stenosis and is increasingly being performed in low-risk patients. Data from randomized trials including more than 9000 patients demonstrate very promising outcomes after TAVI compared to surgical aortic valve replacement in this patient population. If these positive results sustain over long-term follow-up remains to be determined. Above all, the interdisciplinary heart team remains of paramount importance for decisions on treatment strategies in these patients with severe aortic stenosis.

Was ist wichtig?

• In der Behandlung der hochgradigen Aortenklappenstenose zeigt sich die kathetergestützte Aortenklappenimplantation (TAVI) dem Aortenklappenersatz (AKE) bei Patienten mit niedrigem und intermediärem operativem Risiko über den bislang untersuchten Beobachtungszeitraum bei geringerer Invasivität mindestens ebenbürtig, unter bestimmten Aspekten sogar überlegen.

• Insbesondere Langzeitdaten von Studien aus der klinischen Praxis sind noch erforderlich, um offene Fragen zur Durchführung der TAVI in einem jüngeren Niedrigrisiko-Kollektiv abschließend zu beantworten.

• Das interdisziplinäre Herzteam bleibt integraler Bestandteil der Indikationsstellung und Therapieplanung im Sinne eines auf den Patienten individuell zugeschnittenen Behandlungskonzepts.

Schlüsselwörter

Aortenklappenstenose - TAVI - AKE

Keywords

TAVI - TAVR - SAVR - aortic stenosis

Publication History

Article published online:
05 February 2025

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