Transkatheter-Aortenklappenimplantation – Was muss der Anästhesist wissen und beachten?

Zusammenfassung

Die Versorgung herzchirurgischer Patienten ist in den letzten Jahren im Wesentlichen durch 3 Entwicklungen gekennzeichnet, die gleichermaßen eine qualifizierte kardiologische, herzchirurgische sowie anästhesiologische Betreuung der betroffenen Patienten erfordern. Zu diesen Entwicklungen gehören zunehmend älter werdende Patienten mit relevanten Komorbiditäten, die wachsende Zahl an Kombinationseingriffen auch bei diesen älteren Patienten sowie die ebenfalls rapide steigende Anzahl von Hochrisikopatienten mit schwerer Aortenklappenstenose zur minimalinvasiv durchgeführten Transkatheter-Aortenklappenimplantation (TAVI). In den vergangenen 7 Jahren ist dieses interventionell-operative „Hybrid-Verfahren“ in Deutschland von nahezu 0 auf ca. 10500 Eingriffe im Jahr 2013 angewachsen und wird mittlerweile an über 80 Zentren angeboten. Dieses Patientenkollektiv ist durch eine Reihe schwerer Begleiterkrankungen charakterisiert, die das Risiko perioperativerKomplikationen relevant erhöhen, aber auch mit einer deutlich höheren Letalität assoziiert sind. Die Kombination eines Hochrisikopatienten-Kollektivs mit den verfahrensimmanenten Besonderheiten der TAVI-Prozedur stellt besondere Anforderungen an den betreuenden Anästhesisten.

Abstract

Recent advancements in the field of cardiovascular surgery have been dominated by 3 aspects that comparably challenge a sophisticated cardiological, surgical and anaesthesiological management of this patient population. The proportion of elderly patients with relevant comorbidities increases steadily, and the number of combined cardiac surgical procedures is rising in this elderly population. A very important innovation in the last decade pertaining to the treatment of elderly patients at high risk suffering from significant aortic stenosis is the minimally invasive transcatheter aortic valve implantation (TAVI). Over the last 7 years this interventional-surgical „hybrid-procedure“ has increased in numbers from almost 0 to 10 500 procedures in 2013 in Germany, performed at more than 80 centers. These patients relevant comorbidities accounting for a high risk of perioperative complications and moreover for a high mortality. The combination of a patient at high risk with the specific characteristics of the TAVI procedure necessitates to update the required skills of anaesthetists responsible for providing care for this kind of procedure.

Schlüsselwörter:

Anästhesie - Aortenklappenimplantation - TAVI - transfemoral - transapikal - transaortal - minimal-invasiv - Aortenklappenstenose

Key words:

anaesthesia - transcatheter aortic valve implantation - TAVI - transfemoral - transapical - transaortic - minimally invasive - aortic valve stenosis

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