Aortenvitien – interventionelle Therapie

Zusammenfassung

Innerhalb der letzten Jahre wurde die kathetergestützte Aortenklappenimplantation (TAVI) bei älteren Hochrisikopatienten in vielen klinischen Studien evaluiert. In diesen konnte gezeigt werden, dass die TAVI einer medikamentösen Therapie bei inoperablen Patienten mit hochgradiger Aortenklappenstenose hinsichtlich einer Prognoseverbesserung überlegen ist. Außerdem liefert die TAVI bei operablen Risikopatienten mit Aortenklappenstenose ebenso gute Ergebnisse wie der konventionelle Aortenklappenersatz. Ein weiteres Anwendungsgebiet der TAVI stellt die Therapie degenerierter Aortenklappenbioprothesen dar, die in kleineren Studien machbar und sicher erscheint. Die Valvuplastie der degenerierten, hochgradigen Aortenklappenstenose sollte nur noch unter palliativem Ansatz bzw. als „bridge to TAVI/bridge to surgery“ zum Einsatz kommen.

Abstract

Transcatheter aortic valve implantation has been widely studied during the last years. TAVI using the balloon-expandable Edwards SAPIEN valve has been shown to be superior to standard medical therapy in inoperable patients and to be non-inferior to surgical aortic valve replacement in high-risk patients with aortic stenosis. In addition, TAVI using several self expandable transcatheter heart valves, e.g. Medtronic CoreValve, JenaValve or Acurate valve has been demonstrated to be safe and associated with an improvement in hemodyamics and symptoms in high-risk patients with aortic stenosis. In addition, TAVI appears to be an alternative to conventional re-operations in patients with a failing bioprosthetic heart valve. Although balloon valvuloplasty of a stenotic aortic valve leads to a decline in gradient, the results are not long-lasting. Therefore, ballon valvuloplasty can only be considered a “bridge to TAVI/bridge to surgery” or a palliative approach in those that do not qualify for TAVI.

Schlüsselwörter

Aortenklappenstenose - TAVI - konventioneller Aortenklappenersatz - Edwards SAPIEN THV - Medtronic CoreValve Revalving System

Key words

aortic valve stenosis - transcatheter aortic valve implantation - surgical aortic valve replacement - Medtronic CoreValve Revalving System - Edwards SAPIEN THV

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