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MitraClip® zur Therapie der Trikuspidalinsuffizienz

MitraClip® for treatment of tricuspid valve insufficiency

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Zusammenfassung

Die Trikuspidalklappeninsuffizienz findet sich v. a. durch funktionelle Veränderungen des rechten Ventrikels bei fortgeschrittenen Linksherzerkrankungen. Die medikamentöse Therapie ist beschränkt auf Diuretika und die Behandlung der kardialen oder pulmonalen Grunderkrankung. Nur ein kleiner Prozentsatz der Patienten mit Trikuspidalklappeninsuffizienz kann einer chirurgischen Therapie zugeführt werden, dann meist als „Mitbehandlung“ bei Eingriffen am linken Herzen. Kathetergestützte Verfahren stellen eine attraktive Behandlungsoption dar, gerade da die starke prognostische Bedeutung der Trikuspidalinsuffizienz unabhängig von der kardialen Grunderkrankung einen Therapiebedarf suggeriert. Für das MitraClip®-System liegt eine große klinische Anwendungserfahrung für die Behandlung der Mitralinsuffizienz vor. Eine erste Fallserie zeigt, dass ein Einsatz an der Trikuspidalklappe technisch möglich ist, sicher zu sein scheint und den Grad der Trikuspidalinsuffizienz reduzieren kann. In dieser Arbeit werden die Hintergründe der Therapie der Trikuspidalinsuffizienz sowie die ersten Erfahrungen und Perspektiven des MitraClip®-Systems in dieser Anwendung zusammengefasst und bewertet.

Abstract

Tricuspid valve regurgitation is frequently found as a result of right ventricular remodeling due to advanced left heart diseases. Drug treatment is limited to diuretics and the cardiac or pulmonary comorbidities. Due to the high risk only a small percentage of patients are amenable to surgical treatment of tricuspid regurgitation in those who undergo left-sided surgery for other reasons. Catheter-based procedures are an attractive treatment alternative, particularly since the strong prognostic impact of tricuspid regurgitation suggests an unmet need of treatment, independent of the underlying heart disease. A vast amount of clinical experience exists for the MitraClip system for treatment of mitral regurgitation. A first case series shows that the application for treatment of tricuspid regurgitation is technically feasible, seems to be safe and the degree of valve regurgitation can be reduced. In this review the background of tricuspid regurgitation treatment is summarized and first experiences and perspectives with the MitraClip system are assessed.

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Authors and Affiliations

  1. Medizinische Klinik III, Herzzentrum, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    R. Pfister &  S. Baldus

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  1. R. Pfister
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  2. S. Baldus
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Correspondence to R. Pfister.

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R. Pfister und S. Baldus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pfister, R., Baldus, S. MitraClip® zur Therapie der Trikuspidalinsuffizienz. Herz 42, 644–650 (2017). https://doi.org/10.1007/s00059-017-4602-1

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