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Kathetergestützte Aortenklappenimplantation

Was müssen Anästhesisten wissen?

Transcatheter aortic valve implantation

What do anesthetists need to know?

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Zusammenfassung

Der chirurgische Aortenklappenersatz gilt als Goldstandard in der Therapie der hochgradigen Aortenklappenstenose. Die veränderte Demografie konfrontiert die behandelnden medizinischen Fachdisziplinen jedoch mit einem zunehmend höheren Risikoprofil der Patienten; dies machte die Entwicklung neuer weniger invasiver Behandlungsalternativen in der operativen Therapie der Aortenklappenstenose erforderlich. Dieser Entwicklungsprozess führte über die Minithorakotomie hin zur kathetergestützten Aortenklappenimplantation („transcatheter aortic valve implantation“, TAVI). Die TAVI ist ein neues therapeutisches Verfahren zur Behandlung von Patienten mit hochgradiger Aortenklappenstenose und hohem perioperativen Morbiditäts- sowie Mortalitätsrisiko für einen konventionellen Aortenklappenersatz. Da die TAVI am schlagenden Herzen ohne Sternotomie und Herz-Lungen-Maschine durchgeführt werden kann, eignet sich dieses Verfahren insbesondere für den älteren, multimorbiden und/oder kardial voroperierten Patienten. Die ersten Ergebnisse großer prospektiver Multizenterstudien unterstreichen den Stellenwert der TAVI in der modernen Behandlung von Hochrisikopatienten mit symptomatischer Aortenklappenstenose. Die TAVI erfordert vom Anästhesisten neben dem Verständnis des chirurgischen Ablaufs die genaue Kenntnis des perioperativen anästhesiologischen Managements und der möglichen Komplikationen des Verfahrens.

Abstract

Surgical replacement of aortic valves is the gold standard for therapy of high grade aortic valve stenosis. However, the changes in demography confront the responsible medical discipline with an increasingly higher risk profile of patients which necessitates the development of new less invasive alternative forms of treatment for the surgical therapy of aortic valve stenosis. This developmental process has progressed from mini-thoracotomy to transcatheter aortic valve implantation (TAVI). The TAVI procedure is a new therapeutic option for treatment of patients with high grade aortic valve stenosis and high perioperative morbidity and mortality risks with conventional aortic valve replacement. Because TAVI can be carried out while the heart is still beating and without a sternotomy or heart-lung maschine, this procedure is particularly suitable for elderly multimorbid patients and/or patients with previous cardiac surgery. The initial results of large prospective multicenter studies underline the value of TAVI in the modern treatment of high risk patients with symptomatic aortic valve stenosis. In addition to an understanding of the surgical procedure, anesthetists must have precise knowledge of the perioperative anesthesia management and possible complications of the procedure.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: F. Nietlispach arbeitet als Consultant für Edwards Lifesciences Ltd. Die anderen Autoren geben an, dass keine Interessenkonflikte bestehen.

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Authors and Affiliations

  1. Departement für Anästhesie und Intensivmedizin, Universitätsspital Basel, Spitalstr. 21, 4031, Basel, Schweiz

    C. Riediger &  J. Fassl

  2. Abteilung für Kardiologie, Universitätsspital Basel, Basel, Schweiz

    F. Nietlispach

  3. Klinik für Herzchirurgie, Universitätsspital Basel, Basel, Schweiz

    F. Rüter

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  1. C. Riediger
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  2. F. Nietlispach
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  3. F. Rüter
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  4. J. Fassl
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Correspondence to J. Fassl.

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Riediger, C., Nietlispach, F., Rüter, F. et al. Kathetergestützte Aortenklappenimplantation. Anaesthesist 60, 1095–1108 (2011). https://doi.org/10.1007/s00101-011-1972-2

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