Follow up-Management nach interventionellem Aortenklappenersatz

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

Publication History

Article published online:
15 August 2022

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