Perkutane Aortenklappeninterventionen – Eine Standortbestimmung

Nach wie vor stellt die Behandlung von betagten Patienten mit hochgradiger Aortenklappenstenose eine klinische Herausforderung dar, unter anderem da deren perioperative Mortalität im Falle eines konventionellen Aortenklappenersatzes aufgrund vielfältiger Begleiterkrankungen erhöht ist. Die retrograde perkutane Aortenklappenimplantation unter Verwendung des CoreValve Revalving System oder der Edwards SAPIEN transcatheter heart valve (THV) stellt bei diesen Hochrisikopatienten eine Alternative zum konventionellen Aortenklappenersatz dar. Der Fokus dieses Artikels liegt auf der Beschreibung des Patientenscreenings, der Prothesenimplantation und der postoperativen Komplikationen. Die Daten erster klinischer Studien sprechen dafür, dass die perkutane Implantation der Edwards SAPIEN THV als auch der CoreValve Prothese machbar sowie sicher ist und mit einer Verbesserung der hämodynamischen Situation einhergeht. Dennoch sind große Multicenter–Studien notwendig um zu beweisen, dass die langfristigen Ergebnisse der perkutanen Aortenklappenimplantation mit denen des konventionellen Aortenklappenersatzes bei Hochrisikopatienten mit Aortenklappenstenose vergleichbar sind.

Treatment of aortic stenosis remains challenging in older individuals, since their perioperative mortality for conventional aortic valve replacement increases due to co–morbidities. Retrograde percutaneous aortic valve replacement with the CoreValve ReValving System and the Edwards SAPIEN transcatheter heart valve represents an alternative to conventional valve surgery in high risk patients. The primary focus of this article is the description of patient screening, the procedure itself and postoperative complications that are associated with percutaneous aortic valve implantation. Early results of landmark trials suggest that percutaneous aortic valve replacement with either one of the prosthesis is feasible, safe, improves hemodynamics and, therefore, might be an alternative in very high–risk patients for conventional aortic valve replacement. Nevertheless, large multicenter trials are required to show that the long–term results of interventional aortic valve implantation compare favourable to conventional aortic valve replacement in high risk patients with aortic stenosis

Key words

Aortic stenosis - aortic valve replacement - percutaneous - CoreValve Revalving System - Edwards SAPIEN THV

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