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Kardiologie up2date 2013; 09(04): 279-293
DOI: 10.1055/s-0033-1359153
Herzklappenerkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Welche Herzklappe für welchen Patienten – Selektion der Klappen interventionell und konventionell

Sabine Bleiziffer
,
Magdalena Dorfmeister
,
Rüdiger Lange
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Publication History

Publication Date:
14 January 2014 (online)

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Abstract

Prosthesis choice for aortic or mitral valve replacement should be individualized and discussed by an interdisciplinary heart team and the informed patient. Taking into account the age, comorbidities, compliance and lifestyle of the patient, the heart team should evaluate if a patient can undergo mechanical or biological conventional heart valve replacement, or if a catheter based procedure should be offered. A mechanical valve is indicated if the patient already has a mechanical valve, or if there is an increased risk for degeneration of a biological prosthesis, and if there are no contraindications for lifelong anticoagulation. A biological valve is indicated if good quality anticoaguloation is unlikely, bleeding risk is increased, or previous mechanical valve thrombosis has occurred. A bioprosthesis should also be considered in young women contemplating pregnancy. Transcatheter valve procedures (TAVI) are an alternative to the conventional procedure in patients with high surgical risk. The experience of the heart team is of utmost importance for the assessment and decision making. The results of ongoing large randomized trials will further specify the indications for TAVI.

Kernaussagen

  • Die Entscheidung über die Wahl der richtigen Prothese für den Aorten- oder Mitralklappenersatz sollte individualisiert durch ein interdisziplinäres „Herzteam“ getroffen werden, welches aus Herzchirurgen, Kardiologen, Anästhesisten und Intensivmedizinern besteht.

  • Unter Berücksichtigung von Alter, Komorbiditäten, Compliance und Lebensstil ist zu beurteilen, ob und mit welchem Risiko ein Patient einer konventionellen herzchirurgischen Operation zum biologischen oder mechanischen Klappenersatz zugeführt werden kann, oder ob ein interventionelles Vorgehen für den Patienten die risikoärmere Option ist.

  • Eine mechanische Prothese ist besonders zu empfehlen, wenn der Patient bereits eine mechanische Prothese erhalten hat, das Risiko der Degeneration einer biologischen Prothese erhöht ist und keine Kontraindikation für eine lebenslange Antikoagulation besteht.

  • Eine biologische Prothese ist besonders zu empfehlen, wenn unsicher ist, ob Antikoagulanzien zuverlässig eingenommen werden, das Blutungsrisiko erhöht ist oder es zur Thrombosierung einer implantierten mechanischen Prothese gekommen ist, obwohl die Antikoagulation ausreichend war. Bei Frauen mit Kinderwunsch sollte eine biologische Prothese ebenfalls in Betracht gezogen werden.

  • Die Katheterklappen sind eine Alternative zur konventionellen Operation, vor allem bei Patienten mit hohem operativem Risiko bzw. Kontraindikationen für eine konventionelle Operation. Hier ist die Erfahrung und Einschätzung durch das Herzteam für die Indikationsstellung von größter Bedeutung. Studienergebnisse werden in naher Zukunft die Indikationen für diese Klappen erweitern.

 

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