Herz

, Volume 38, Issue 8, pp 828–837 | Cite as

ESC-Leitlinien zu Herzklappenerkrankungen

Was ist neu und anders?
Schwerpunkt

Zusammenfassung

Im Jahre 2012 veröffentlichten die Europäische Gesellschaft für Kardiologie (ESC) und die Europäische Vereinigung für Herz-Thorax-Chirurgie (EACTS) erstmalig eine gemeinsame neue Leitlinie zur Behandlung valvulärer Herzerkrankungen. Diese betont vor dem Hintergrund der stark aufkommenden interventionellen Behandlung von Klappenvitien den Einsatz eines Heart-Teams zur Therapieentscheidung. Bei der Aortenwurzelerkrankung im Rahmen eines Marfan-Syndroms ohne Risikofaktoren sehen die Leitlinien jetzt eine Operationsindikation für A. ascendens und Aortenklappe ab einem maximalen Diameter von 50 mm, bei Vorliegen von Risikofakoren ab einem maximalen Durchmesser von 45 mm vor. In Hinsicht auf die Behandlung von Patienten mit Aortenklappenstenose betonen die Leitlinien, dass, falls TAVI-Prozeduren durchgeführt werden, eine Herzchirurgie sowie ein Heart-Team vor Ort sein müssen. Der interventionelle Herzklappenersatz wird gegenwärtig nur für inoperable Patienten oder Patienten mit deutlich erhöhtem Operationsrisiko in Betracht gezogen. Des Weiteren werden Handlungsrichtlinien für Patienten mit paradoxer „Low-flow-low-gradient“-Aortenklappenstenose und für asymptomatische Patienten mit hochgradiger Aortenstenose diskutiert. In Bezug auf die Mitralklappeninsuffizienz ist die operative Rekonstruktion die bevorzugte Technik. Die Indikation bei asymptomatischen Patienten wird detaillierter als zuvor dargestellt, und die perkutane Mitralklappenrekonstruktion mittels MitraClip® wird als Alternative für Hochrisikopatienten besprochen. Hinsichtlich der Trikuspidalklappenerkrankung ist bei sekundärer Insuffizienz die Operationsindikation auf bereits leichtgradige Vitien erweitert worden, sofern eine signifikante Ringdilatation vorliegt und ein linksseitiges Vitium operiert werden soll. Letztendlich ergibt sich ein Vorteil für die Therapie mit niedrigdosierter Acetylsalicylsäure für Patienten nach biologischem Aortenklappenersatz im Vergleich zur oralen Antikoagulation.

Schlüsselwörter

Klappenchirurgie Perkutane Klappenintervention Aortenklappenstenose Mitralklappeninsuffizienz Risikofaktoren 

ESC guidelines on the management of valvular heart disease

What has changed and what is new?

Abstract

In 2012 the new and collaborative “Guidelines on the management of valvular heart disease (version 2012)” were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a“heart team” with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a“heart team” available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the“heart team” to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the“heart team”. Furthermore, low flow – low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least, in patients with aortic bioprostheses the use of low-dose aspirin is now favored for a 3-month postoperative period.

Keywords

Valve surgery Percutaneous valve intervention Aortic valve stenosis Mitral valve insufficiency Risk factors 

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Copyright information

© Urban & Vogel 2013

Authors and Affiliations

  1. 1.Klinik für Innere Medizin/ KardiologieHerzzentrum Leipzig – UniversitätsklinikLeipzigDeutschland

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