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Der Klinikarzt 2017; 46(04): 126-133
DOI: 10.1055/s-0043-105836
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© Georg Thieme Verlag Stuttgart · New York

Die Transkatheter Aortenklappenimplantation

Screening, Diagnostik und KlappenauswahlTranscatheter aortic valve implantation – Screening, diagnosis and valve prosthesis
Won-Keun Kim
1   Kerckhoff-Klinik, Abteilung für Kardiologie, Bad Nauheim
2   Kerckhoff-Klinik, Abteilung für Herzchirurgie, Bad Nauheim
,
Arnaud Van Linden
2   Kerckhoff-Klinik, Abteilung für Herzchirurgie, Bad Nauheim
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Publication History

Publication Date:
24 April 2017 (online)

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Die transkatheter Aortenklappenimplantation (TAVI) ist ein relativ junges, jedoch nunmehr etabliertes Verfahren zur Behandlung von Patienten mit hochgradiger Aortenklappenstenose und hohem operativen Risiko. Ungeachtet der rasanten Fortschritte mit immer besser werdenden Resultaten, ist eine sorgfältige Evaluation für eine optimale Therapieplanung unverzichtbar. Sobald das Vorliegen einer hochgradigen, symptomatischen Aortenklappenstenose gesichert ist, sollte eine Einschätzung des individuellen Risikos erfolgen. Ist schließlich die Indikation für eine TAVI gestellt, wird im nächsten Schritt eine Computertomografie der Aortenwurzel und der Aorta einschließlich der Femoralarterien durchgeführt. Hieraus entscheidet sich die technische Durchführbarkeit einer TAVI, sowie die Wahl des Zugangsweges und der Klappenprothese. Die fortschrittliche Bildgebung trägt der zunehmenden Vielfalt an Klappenprothesen Rechnung, ermöglicht sie doch eine sehr differenzierte Therapie mit einer auf die individuelle Anatomie zugeschnittenen Selektion der Prothese. Voraussetzung hierfür ist allerdings ist eine ausreichende Erfahrung in der Verwendung der verschiedenen Klappensysteme.

Transcatheter aortic valve implantation (TAVI) has emerged as the preferred procedure for the treatment of patients with severe aortic stenosis at high operative risk. Despite major advances of the past years with improving procedural results, careful screening and evaluation remains pivotal for an optimized therapeutic strategy. In the event of severe symptomatic aortic stenosis, as first step the individual peri-procedural risk should be determined, considering various risk-scores and comorbidities. Once the indication for TAVI has been confirmed, the key diagnostic modality to assess the feasibility of TAVI is multislice computed tomography of the aortic root, the complete aorta and femoral arteries. It provides information necessary to choose the appropriate access site as well as type and size of the prosthesis. This sophisticated imaging takes into account the increasing diversity of available transcatheter heart valves and allows for a customized differential therapy.

Key words

Aortic stenosis - transcatheter aortic valve implantation (TAVI) - screening - valve prosthesis
 

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