Mitralvitien – interventionelle Therapie

Zusammenfassung

Die Mitralklappeninsuffizienz ist ein häufiges Vitium des älteren Patienten und eine relevante Anzahl an Patienten mit begleitenden Komorbiditäten, die das Risiko einer operativen Korrektur erhöhen, wird den klassischen chirurgischen Verfahren nicht zugeführt. Da eine schwerwiegende symptomatische Mitralklappeninsuffizienz Lebensqualität und Prognose deutlich verschlechtert, ist die Entwicklung therapeutischer Alternativen erforderlich. Neue katheterinterventionelle Verfahren greifen auf unterschiedlichen Ebenen des Mitralklappenapparats an und befinden sich zum Großteil noch im Stadium der präklinischen Entwicklung. Lediglich das MitraClip-System© ermöglicht bereits die minimalinvasive Korrektur des Klappenvitiums über eine Koaptation der Klappensegel. Die Sicherheit der Prozedur konnte überwiegend bei symptomatischen Hochrisikopatienten mit funktioneller Mitralklappeninsuffizienz nachgewiesen werden. Es ist derzeit noch unklar, ob durch dieses Verfahren eine nachhaltige Korrektur der Klappeninsuffizienz möglich ist und inwiefern die interventionelle Reduktion der Mitralklappeninsuffizienz die Prognose der behandelten Patienten positiv beeinflusst. In Zukunft werden die neuen katheterinterventionellen Verfahren die Therapie von Patienten mit symptomatischer funktioneller oder degenerativer Mitralklappeninsuffizienz maßgeblich beeinflussen.

Abstract

Mitral valve regurgitation (MR) is a common disease of the elderly, and a relevant percentage of patients with MR cannot undergo surgical valve repair because of concomitant co-morbidities increasing the individualsʼ perioperative mortality risk. However, since the presence of a relevant MR relevantly decreases the patientsʼ prognosis there is an unmet need for interventional alternatives to the conventional valve surgery. New catheter-based interventions approach different parts of the mitral valve apparatus, and the majority of these techniques are still undergoing pre-clinical research. Up to date only the MitraClip© system is available for clinical use aiming to reduce MR by direct edge-to-edge repair of the mitral valve leaflets. The available results from clinical studies confirm the safety and efficacy of this procedure predominantly in high-risk patients with functional MR. The durability of this procedure and the impact of MR reduction by means of the MitraClip© system on the patientsʼ prognosis is still on debate. Future developments of these catheter-based, less invasive techniques will relevantly influence decision making on patients with symptomatic mitral valve insufficiency.

Schlüsselwörter

Mitralklappeninsuffizienz - Risikostratifizierung - Klappenchirurgie - interventionelle Mitralklappentherapie

Key words

mitral valve regurgitation - risk stratification - surgical valve repair - transcatheter mitral valve therapy

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