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DOI: 10.1055/a-1884-5723
Operativer und kathetergestützter Aortenklappenersatz – zwischen Evidenz und Empfehlung
Surgical and Transcatheter Aortic Valve Replacement – Between Evidence and RecommendationZusammenfassung
Patienten mit hochgradig symptomatischer Aortenklappenstenose haben unbehandelt eine reduzierte Lebenserwartung. Die operative und interventionelle Behandlung der Aortenklappe stehen als Behandlungsoptionen zur Verfügung. Entsprechend aktueller Leitlinien der EACTS/ESC und der DGTHG/DGK ist bei jüngeren Patienten mit niedrigem operativem Risiko weiterhin der operative Aortenklappenersatz (AKE) das Behandlungsverfahren der Wahl. Bei älteren Patienten bzw. Patienten mit erhöhtem operativem Risiko ist die interventionelle Aortenklappenimplantation (TAVI) die präferierte Methode. Im klinischen Alltag ist neben diesen Empfehlungen aber viel entscheidender, dass nach entsprechender Vordiagnostik unter Berücksichtigung der anatomischen Gegebenheiten, Komorbiditäten und individuellen Aspekten gemeinsam im Herzteam (repräsentiert durch eine/einen Herzchirurgen/in und interventionellen Kardiologen/in) mit dem Patienten eine optimale individuelle Entscheidung zur Behandlung getroffen wird.
Abstract
Untreated symptomatic severe aortic stenosis is associated with reduced survival. Surgical and interventional treatment is currently available. According to EACTS/ESC guidelines and DGTHG/DGK position paper surgical aortic valve replacement is the recommended treatment in younger patients with low surgical risk. Whereas in older patients or in patients with elevated surgical risk interventional aortic valve implantation (TAVI) should be preferred. In current clinical routine however, it is much more important to treat the patient based on an individualized decision considering various aspects (anatomic features, comorbidities, individual factors). This decision should be made by the heart team involving a cardiac surgeon and an interventional cardiologist in the context of “shared decision making”.
Als Behandlungsoptionen für Patienten mit hochgradig symptomatischer Aortenklappenstenose stehen der interventionelle (TAVI) bzw. chirurgische Aortenklappenersatz (AKE) zur Verfügung. Laut aktueller EACTS-ESC-Leitlinien ist für jüngere Patienten mit niedrigem OP-Risiko der AKE, für ältere Patienten mit erhöhtem OP-Risiko die TAVI die Behandlungsmethode der Wahl. Entscheidend ist jedoch hierbei, dass die individuelle optimale Entscheidung für die eine oder andere Methode im Heart Team unter Berücksichtigung anatomischer Gegebenheiten, Komorbiditäten, des Risikoprofils und auch des Patientenwunsches getroffen wird.
Publication History
Article published online:
05 October 2022
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