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Patienten mit Klappenvitium auf der Intensivstation

Patients in the intensive care unit with valvular diseases

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Zusammenfassung

Eine Klappendysfunktion ist ebenso häufig Ursache für eine akut dekompensierte Herzinsuffizienz wie ein akutes koronares Syndrom. Mit zunehmendem Alter der Patienten steigt die Wahrscheinlichkeit für ein relevantes Klappenvitium und beträgt bei über 75-jährigen mehr als 10 %. Therapierichtlinien und Studien für diese Patienten im intensivmedizinischen Bereich sind trotz hervorragender Leitlinien zur Behandlung von Herzklappenerkrankungen in allgemeinen Patientenpopulationen (z. B. Leitlinien der European Society of Cardiology) aber rar. Für die extremste Präsentationsform einer Klappendysfunktion, dem kardiogenen Schock, haben sich in den letzten Jahren bei Versagen der medikamentös therapeutischen Therapieoptionen und drohender bzw. bestehender Organdysfunktion in Einzelfällen therapeutische Alternativen erfolgreich erwiesen (z. B. Ballonvalvuloplastie bei Aortenklappenstenose, extrakorporale Membranoxygenierung/perkutan implantierbare ventrikuläre Unterstützungssysteme, Mitraclipping). Diese Therapien sind bei Klappendysfunktion und Schock als „bridge to operation“ zu sehen, ist doch die Klappenersatz-/Klappenrekonstruktionsoperation nach wie vor der anzustrebende Goldstandard bei der Behandlung dieser Erkrankungen. Eine Stabilisierung des Patienten und die Verbesserung der Organfunktionen ist jedoch entscheidend, um eine Operation zu ermöglichen.

Abstract

Valvular dysfunction is as frequent as acute coronary syndromes in the pathogenesis of acute decompensated heart failure. The prevalence of relevant valvular dysfunction increases with age and reaches more than 10 % in patients over 75 years old. Guidelines and studies on the treatment of these patients, especially in an intensive care unit (ICU) setting are, however, scarce despite excellent guidelines for treatment of valvular heart disease in the general population. In the last decade a number of therapeutic alternatives became available when standard inotrope and vasopressor therapy fails to stabilize patients. These include balloon valvuloplasty in patients with severe aortic valve stenosis and assist devices, extracorporeal membrane oxygenation (ECMO) as well as mitral clipping. These therapeutic alternatives are to be considered as bridge to operation procedures in cases of shock due to valvular dysfunction, as hemodynamic stabilization and stabilization of organ function are essential to allow valve repair/replacement which is still considered to be the gold standard in this situation but is not always possible in the acute setting.

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  1. 3. Medizinische Abteilung mit Kardiologie, Wilhelminenspital der Stadt Wien, Montlearstr. 37, 1160, Wien, Österreich

    A. Geppert

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Geppert, A. Patienten mit Klappenvitium auf der Intensivstation. Med Klin Intensivmed Notfmed 108, 555–560 (2013). https://doi.org/10.1007/s00063-012-0140-z

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