Nicht invasive Bildgebung bei Klappeninterventionen – welche Parameter braucht das Herzteam zur Entscheidung?

Abstract

Transcatheter techniques for valve repair or valve implantation have become standard procedure in the group of high risk patients or those deemed inoperable. Data from the German Aortic Valve Registry „Gary“ show similar survival and MACE rates of TAVI patients as compared to conventional surgery in the high risk group. In case of mitral regurgitation data from the Euro Heart Survey show that up to 50 % of patients with severe mitral regurgitation are not referred or deem inoperable. Data from the EVEREST I and II trials not only demonstrate sufficient reduction of MR but also reduced clinical events. It is therefore important to identify high risk patients with severe valve disease, who would benefit from transcatheter techniques. Multimodality imaging is the anwser to this need. It identifies the right patients, guides procedures and helps to monitor the postinterventional period. Multimodality imaging has therefore become an integral part in any heart team discussion.

Kernaussagen

• Die interventionellen Verfahren sind in der Gruppe der Hochrisikopatienten mittlerweile zum Standardverfahren der Klappentherapie geworden. Ihre Ergebnisse sind in dieser Gruppe mit denen der konventionellen Operation vergleichbar.

• Entscheidend für eine erfolgreiche Therapie mit gutem Langzeitergebnis ist die sorgfältige Patientenselektion und Diskussion der Selektionskriterien im Herzteam.

• Die nicht invasive Bildgebung liefert hier wichtige Daten von der Diagnose über prozedurale Parameter bis hin zu Ergebniskriterien, auf die das Herzteam heute nicht mehr verzichten kann. Für den klinisch tätigen Kardiologen sollten diese Parameter daher integraler Bestandteil seiner Aus- und Weiterbildung sein.

• Literatur

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