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Aktuelle Technologien zur interventionellen Therapie der Trikuspidalklappeninsuffizienz

Current technologies in interventional treatment of tricuspid valve regurgitation

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Zusammenfassung

Die schwere Trikuspidalklappeninsuffizienz (TI) ist insbesondere in der älteren Bevölkerung eine lange Zeit unterschätzte Erkrankung mit hoher assoziierter Morbidität und Mortalität. Aufgrund der hohen perioperativen Mortalität der Trikuspidalklappenchirurgie stellte lange nur die medikamentöse Therapie eine praktikable Behandlungsoption dar. Interventionelle Herangehensweisen konnten in ersten Studien aussichtsreiche Ergebnisse mit effektiver Reduktion der TI bei gleichzeitigem Nachweis einer sicheren Intervention erzielen. Grundsätzlich können die aktuell verfügbaren interventionellen Behandlungsoptionen in 3 Therapiekonzepte (Koaptationsysteme [„edge-to-edge repair“], Annuloplastie und interventioneller Klappenersatz) eingeteilt werden. Die größte klinische Erfahrung und beste wissenschaftliche Datenlage konnten bislang im Bereich der Koaptationssysteme generiert werden. Sehr aussichtsreiche erste Ergebnisse mit effektiver Reduktion der TI und Verbesserung der klinischen Beschwerdesymptomatik liegen jedoch auch zum interventionellen Klappenersatz vor. Eckpfeiler einer erfolgreichen Behandlung der TI in diesem komplex kranken Patientenkollektiv stellt die umfangreiche präinterventionelle Diagnostik mit Auswahl des für den Patienten individuell am besten geeigneten Therapiekonzepts dar. Studien im prospektiv randomisierten Design werden zukünftig den Nutzen der interventionellen Behandlung der TI gegenüber einem rein konservativen Therapiekonzept untersuchen.

Abstract

For a long time, severe tricuspid valve regurgitation (TR) was an underestimated disease, especially in the older population and was associated with high morbidity and mortality. Due to the high perioperative mortality of tricuspid valve surgery, historically only pharmaceutical treatment was a practical treatment option. In the first studies interventional approaches could achieve promising results with an effective reduction of TR with simultaneous proof of a convincing safety profile. Conceptually, the currently available interventional treatment options can be divided into three concepts: coaptation systems (edge-to-edge repair), annuloplasty and interventional valve replacement. The largest clinical experience and best scientific body of evidence could so far be generated in the field of coaptation systems. Very promising preliminary results with effective reduction of TR and improvement of the clinical symptoms are, however, also available for interventional valve replacement. Meticulous preprocedural diagnostics with selection of the most suitable treatment option for each individual patient is paramount for successful treatment in this critically ill patient cohort. Future prospective randomized studies will investigate the net benefit of an interventional treatment of TR in comparison to a purely conservative treatment concept.

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  1. Klinik für Innere Medizin/Kardiologie, Universität Leipzig – Herzzentrum, Strümpellstraße 39, 04289, Leipzig, Deutschland

    Sebastian Rosch MD & Philipp Lurz MD PhD

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Correspondence to Philipp Lurz MD PhD.

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Interessenkonflikt

P. Lurz: consultant of Edwards Lifesciences, Medtronic, Abbott Vascular, ReCor and research relationship to Edwards Lifesciences, ReCor. S. Rosch gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Rosch, S., Lurz, P. Aktuelle Technologien zur interventionellen Therapie der Trikuspidalklappeninsuffizienz. Herz 46, 437–444 (2021). https://doi.org/10.1007/s00059-021-05056-9

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