Intensivmedizinische Aspekte der interventionellen Therapie von Herzklappenerkrankungen

Was ist neu?

Intensivmedizinische Nachbehandlung der interventionellen Aortenklappenintervention (TAVI) Durch die Indikationsausweitung der TAVI auf Patienten mit intermediären Operationsrisiko und der gleichzeitigen Vorgabe zur Einhaltung struktureller Voraussetzungen für die postinterventionelle intensivmedizinische Versorgung durch den GBA werden zukünftig große logistische, kapazitäre und personelle Herausforderungen an die Intensivmedizin gestellt.

Interventionelle Mitralklappentherapie mittels MitraClip-Verfahren Mit der hauptsächlichen MitraClip^®-Behandlung von Patienten mit funktioneller Mitralinsuffizienz auf dem Boden einer eingeschränkten linksventrikulären Funktion im klinischen Alltag stellt dieses interventionelle Therapieverfahren eine intensivmedizinische Herausforderung in der frühen postinterventionellen Phase dar.

• Literatur

• 1 Gaede L, Blumenstein J, Won-Keun K. et al. Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repair. Clin Res Cardiol 2017; 106: 411-419
• 2 Beschluss des Gemeinsamen Bundesausschusses über eine Richtlinie zu minimalinvasiven Herzklappeninterventionen: Richtlinie zu minimalinvasiven Klappeninterventionen – 22.1.2015. BAnz AT 24.7.2015 B6
• 3 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
• 4 Reardon MJ, van Mieghem JJ, Popma NS. et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med April 2017; 376: 1321-1331
• 5 Al-Rashid F, Kahlert P, Selge F. et al. Risk assessement of patients undergoing transfemoral aortic valve implantation upon admission for post-interventional intensive care and surveillance: implications on short- and midterm outcomes. PLoS ONE 2016; 11: e0167072
• 6 Kapetein AP, Head SJ, Genereux P. et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg 2013; 145: 6-23
• 7 Mayr NP, Michel J, Bleiziffer S. et al. Sedation or general anestheia for transcatherer aortic valve implantation (TAVI). J Thorac Dis 2015; 7: 1518-1526
• 8 Werner N, Zeymer U, Schneider S. et al. Incidence and clinical impact of stroke complicating transcatheter aortic valve implantation: Results from the German TAVI registry. Catheter Cardiovasc Interv 2016; 88: 644-653
• 9 Giustino G, van der Boon RM, Molina-Martin de Nicolas J. et al. Impact of permanent pacemaker on mortality after transcatheter aortic valve implantation: the PRAGMATIC (Pooled Rotterdam-Milan-Toulouse in Collaberation) Pacemaker substudy. EuroIntervention 2016; 12: 115-1193
• 10 Tirado-Corte G, Freitas-Ferraz AB, Nombela-Franco L. et al. Incidence, causes and impact of in-hospital infections after transcather aortic valve implantation. Am J Cardiol 2016; 118: 403-409
• 11 Bagur R. et al. Acute kidney injury following transcatheter aortic valve implantation and the rsik of acute kidney injury. Eur Heart J 2010; 31: 865-874
• 12 Trichon BH, Felker GM, Shaw LK. et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003; 91: 538-543
• 13 Maisano F, Franzen O, Baldus S. et al. Percutaneous mitral valve interventions in the real world: early and 1-year results from the ACCESS-EU, a prospective, multcenter, nonrandomized post-approval study oft he MitraClip therapy in Europe. J Am Coll Cardiol 2013; 62: 1052-1061
• 14 Di Prima AL, Covello DR, Franco A. et al. Do patients undergoing MitraClip implantation require routine ICU admission?. 2014; 28: 1479-1483
• 15 Horn P, Hellhammer K, Minier M. et al. Deep sedation vs. General anesthesia in 232 patients undergoing percutaneous mitral valve repair using the MitraClip system. Catheter Cardiovasc interv 2017 Jan 23. doi: 10.1002/ccd.26884
• 16 Schueler R, Öztürk C, Wedekind JA. et al. Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution. JACC Cardiovasc Interv 2015; 8: 50-459
• 17 Huntgeburth M, Muller-Ehmsen J, Baldus S. et al. Post-interventional iatrogenic atrial septal defect with hemodynamically relevant left-to-right and right-to-left shunt as a complication of successful percutaneous mitral valve repair with the MitraClip. Int J Cardiol 2013; 168: e3-e5