Kathetergestützte Aortenklappenimplantation – TAVI 2014

Kernaussagen

• TAVI gilt heute als Therapie der Wahl bei älteren, inoperablen Patienten sowie als wertvolle Therapiealternative zum chirurgischen Aortenklappenersatz bei Hoch-Risikopatienten.

• Wichtig sind hierbei ein individualisiertes Patientenmanagement sowie die genaue Evaluation der anatomischen Verhältnisse und der technischen Durchführbarkeit. Hierfür kommen komplementäre bildgebende Verfahren zum Einsatz.

• Derzeit stehen primär zwei Bioklappen-Systeme zur Verfügung, die zumeist in Allgemeinanästhesie transfemoral oder transapikal, in seltenen Fällen auch über die Aorta oder die A. subclavia oder A. axillaris eingebracht werden.

• Sowohl kurz nach Implantation als auch im Langzeitverlauf findet sich nach TAVI eine gute Klappenfunktion bei verbesserter Belastbarkeit und Lebensqualität der Patienten. Im direkten Vergleich zu Patienten mit chirurgischem Klappenersatz zeigen sich ähnliche Mortalitätsraten.

• Die Zahl der Komplikationen geht bedingt durch technische Optimierung und Anwendererfahrung stetig zurück und wird durch die Entwicklung neuer Prothesen weiter reduziert werden können.

• Seit Einführung hat die THV ihr Einsatzgebiet ferner um die Behandlung der Prothesendysfunktion nach SAVR erweitert, und auch für die Therapie der isolierten Aortenklappeninsuffizienz wird TAVI inzwischen angewendet.

• Ungeachtet der positiven PARTNER-Daten sowie der guten kurz-, mittel- und langfristigen Registerergebnisse sollten Kardiologen und Herz- und Gefäßchirurgen gemeinsam in enger interdisziplinärer Zusammenarbeit die Weiterentwicklung des Verfahrens vorantreiben. Ziel muss es sein, durch Erfahrungsaustausch und Kompetenzaufbau sowie durch eine standardisierte Patientenselektion und ein optimales periprozedurales Management TAVI-assoziiert Komplikationen zu reduzieren und langfristig den Erhalt der Lebensqualität zu sichern. Aktuelle Einschränkungen im Indikationsspektrum können dann aufgehoben und neue Therapiestrategien entwickelt werden.

• Literatur

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