Perkutane Aortenklappenimplantation (TAVI)

Zusammenfassung

Hintergrund und Fragestellung: Die perkutane kathetertechnische Aortenklappenimplantation (TAVI) entwickelt sich zu einer neuen Therapieoption für Patienten mit symptomatischer schwerer Aortenstenose, wenn diese inoperabel oder operative Hochrisikopatienten sind.

Patienten und Methoden: Von August 2008 bis Ende 2009 wurde bei 60 Patienten eine TAVI durchgeführt. Das durchschnittliche Alter der Patienten betrug 82 ± 6,1 Jahre, 41,7 % waren Männer und der mittlere EuroScore betrug 25,8 ± 17,0 %. Die Indikationen zur TAVI waren in den meisten Fällen ein sehr hohes operatives Risiko.

Ergebnisse: Die technische Erfolgsrate betrug 98,3 %. Der durchschnittliche Druckgradient konnte auf 2,8 ± 7,0 mm Hg gesenkt werden. Eine signifikante Aorteninsuffizienz (≥ Grad III) trat bei 6 Patienten (10 %) auf, wovon die meisten kathetertechnisch verbessert werden konnten. Die durchschnittliche Krankenhausliegedauer betrug 15,4 ± 18,9 Tage. Ein permanenter Schrittmacher musste bei 22 der 60 Patienten (36,7 %) implantiert werden. Insgesamt starben 8 Patienten (13,3 %) während des stationären Aufenthaltes, die Mehrzahl aus nicht direkt interventionsbezogenen Gründen.

Folgerung: Die TAVI entwickelt sich im klinischen Alltag zu einer neuen Therapieoption für hochbetagte, multimorbide Patienten mit schwerer symptomatischer Aortenstenose. Die Komplikationsrate ist jedoch nicht unbeträchtlich und verlangt Erfahrung in zum Teil sonst ungebräuchlichen interventionellen Therapien.

Abstract

Background: Percutaneous transcatheter aortic valve implantation (TAVI) is a new therapeutic method for patients with severe symptomatic aortic stenosis who are at very high surgical risk or in whom there are contraindications to surgical valve replacement.

Patients and methods: Between August 2008 and December 2009, sixty such patients underwent TAVI at our hospital.

Results: The mean age of the patients was 82 ± 6.1 years, 25 of them were men. The mean „European system for cardiac operative risk” (EuroSCORE) was 25.8 ± 17.0%. A very high surgical risk was the indication for TAVI in 51 patients. The mean aortic valve orifice area was 0.6 ± 0.1cm² and the mean transvalvular gradient 48.2 ± 14.4 mm Hg before the intervention. The mean duration of the intervention was 62.6 ± 19.9 minutes and the screening time 11.8 ± 5.1 minutes. The procedure was technically successful in all but one patient. The post-interventional mean transvalvular gradient was 2.87.0 mm Hg. Significant residual aortic regurgitation (more than grade 3) was present in six patients but was reduced by the catheter-based „snare” technique in most cases. Mean hospital stay was 15.4 ± 18.9 days. A permanent pacemaker was implanted in 22 of the patients. Eight patients died during the hospital stay, most of them for reasons not directly related to the intervention.

Conclusions: TAVI is becoming a new therapeutic method for elderly patients with severe co-morbidities and severe symptomatic aortic stenosis. Complications of TAVI are not trivial and their management by catheter techniques is challenging. In consequence the selection of patients and of suitably experienced hospitals is crucial for the further development of this promising new technique.

Schlüsselwörter

kathetertechnische Aortenklappenimplantation - Valvuloplastie - Aortenklappenersatz - Aortenstenose

Keywords

aortic valve stenosis - transcatheter aortic valve implantation - aortic valve replacement - balloon valvuloplasty

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