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Indikationsstellung und Patientenselektion für die kathetergestützte Behandlung der Mitralklappeninsuffizienz

Empfehlungen der Arbeitsgruppe kathetertechnische Herzklappentherapie der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie

Indications and patent selection for catheter-based treatment of mitral valve regurgitation

Recommendations of the working group on catheter-based heart valve therapy of the German Society for Thoracic and Cardiovascular Surgery

  • Aus der DGTHG
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die symptomatische Mitralklappeninsuffizienz (MI) ist die häufigste Herzklappenerkrankung in der westlichen Welt, deren herzchirurgische oder kathetergestützte Therapie einen multidisziplinären Behandlungsansatz benötigt. Die MI wird ätiologisch in eine primäre und eine sekundäre MI unterteilt, welche unterschiedlichen Behandlungsstrategien unterliegen. Die Einführung kathetergestützter Behandlungsverfahren, insbesondere die perkutanen Mitralklappenrekonstruktion mittels MitraClip® (Fa. Abbott Vascular, Santa Clara, CA, USA), haben hierbei zu einer Erweiterung der Behandlungsmöglichkeiten neben der konventionellen Mitralklappenchirurgie geführt. So kann die perkutane Mitralklappenrekonstruktion mittels MitraClip zur Behandlung der primären und sekundären MI unter definierten Voraussetzungen bei inoperablen und Hochrisikopatienten Anwendung finden. Hierbei ist es die Aufgabe des Herzchirurgen, den multidisziplinären Behandlungsprozess aktiv mitzugestalten.

Aufgrund der Zunahme der Behandlungszahlen von Patienten mit MI sowie deren Therapie mittels kathetergestützter Techniken hat die Arbeitsgruppe kathetertechnische Herzklappentherapie der Deutschen Gesellschaft für Thorax‑, Herz- und Gefäßchirurgie Empfehlungen für die Indikationsstellung und Patientenauswahl im Rahmen einer interdisziplinären Zusammenarbeit im Herzteam erarbeitet.

Abstract

Symptomatic mitral regurgitation (MR) is the most common heart valve disease in western countries and cardiac surgery or catheter-based therapy requires a multidisciplinary treatment approach. The MR is etiologically subdivided into primary and secondary MR, which are subject to different treatment strategies. The introduction of catheter-based treatment methods, in particular percutaneous mitral valve repair using the MitraClip® system (Abbott Vascular, Santa Clara, CA, USA), has led to an expansion of treatment options alongside conventional mitral valve surgery. Percutaneous mitral valve repair using the MitraClip system can be used for the treatment of primary and secondary MR under defined conditions for inoperable and high-risk patients. It is the task of the cardiac surgeon to actively participate in the multidisciplinary treatment process.

Due to the increase in the number of patients with symptomatic MR treated by catheter-based techniques, the working group on catheter-based heart valve therapy of the German Society of Thoracic and Cardiovascular Surgery has developed recommendations for the indications and patient selection within the framework of a multidisciplinary heart team.

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Authors and Affiliations

  1. Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    T. Noack, P. Kiefer, J. Seeburger & D. Holzhey

  2. Klinik für Thorax‑, Herz- und Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland

    A. Van Linden & T. Walther

  3. Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland

    S. Sündermann

  4. Klinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg, Hamburg, Deutschland

    L. Conradi

  5. Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, München, Deutschland

    S. Bleiziffer

  6. Klinik für Herz- und thorakale Gefäßchirurgie, Universitäres Herzzentrum Lübeck, Lübeck, Deutschland

    S. Ensminger

  7. Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    H. Treede

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Interessenkonflikt

T. Noack, A. Van Linden, P. Kiefer, J. Seeburger, S. Sündermann, D. Holzhey, L. Conradi, S. Bleiziffer, S. Ensminger, H. Treede und T. Walther geben an, dass kein Interessenkonflikt besteht.

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

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Noack, T., Van Linden, A., Kiefer, P. et al. Indikationsstellung und Patientenselektion für die kathetergestützte Behandlung der Mitralklappeninsuffizienz. Z Herz- Thorax- Gefäßchir 32, 482–491 (2018). https://doi.org/10.1007/s00398-018-0263-5

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