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Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren

Positionspapier der Deutschen Gesellschaft für Kardiologie

Interventional treatment of AV valvular diseases—Criteria for certification of mitral valve centers

Position paper of the German Cardiac Society

  • Positionspapiere
  • Published:
Der Kardiologe Aims and scope

An Erratum to this article was published on 30 September 2020

This article has been updated

Zusammenfassung

Die Mitral- und Trikuspidalklappeninsuffizienz sind häufige Herzklappenerkrankungen. Sie gehen als unabhängige Risikofaktoren mit einer erhöhten Sterblichkeit bei Herzinsuffizienz einher. Die kathetergestützte Rekonstruktion der Klappen stellt eine mittlerweile relevante Alternative zur rein medikamentösen bzw. chirurgischen Behandlung dar. Während die kathetergestützte Therapie der Trikuspidalklappeninsuffizienz in ersten Registern Effektivität und Sicherheit demonstrierte, liegen für die kathetergestützte Therapie der Mitralklappeninsuffizienz mittlerweile mehrere randomisierte Studien vor. Dieses Papier stellt die Ergebnisse aktueller Studien dar und gibt Empfehlungen zur Indikation interventioneller Behandlungsverfahren bei Mitral- und Trikuspidalklappeninsuffizienz. Zur Sicherung der Qualität dieser Verfahren werden von der Deutschen Gesellschaft für Kardiologie die Kriterien für die Zertifizierung von Zentren zur kathetergestützten Therapie der Mitralklappeninsuffizienz aktualisiert.

Abstract

Mitral and tricuspid regurgitation are highly prevalent types of valvular heart disease, important drivers of a poor prognosis and subject to catheter-based treatment. The transcatheter reconstruction of the valves has meanwhile evolved as an important alternative to pure medicinal treatment and surgical interventions. Whereas transcatheter treatment of tricuspid valve insufficiency has recently shown effectiveness and safety in the first registries, transcatheter treatment of mitral valve insufficiency has meanwhile been tested in several randomized trials. This paper comments on the results of these trials and presents recommendations regarding the indications for the interventional treatment modalities available for mitral and tricuspid valve regurgitation. As part of this manuscript and in an effort to further improve the quality of care, the German Cardiac Society has updated the criteria for the certification of centers for transcatheter treatment of mitral valve insufficiency.

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Abb. 1

Change history

  • 30 September 2020

    In der Legende der Abb.��1 des Originalbeitrags wurde die Abk��rzung ���TMVR��� falsch aufgel��st. Richtig muss es hei��en: ���TMVR kathetergest��tzte Mitralklappenrekonstruktion���. Nachfolgend finden Sie die Abbildung mit der korrekten Legende. Wir bitten, diesen Fehler zu entschuldigen und die korrigierte ���

Abbreviations

ACB:

Aortokoronarer Bypass

ARNI:

Angiotensin-Rezeptor‑/Neprilysin-Inhibitor

AV-Klappe:

Atrioventrikularklappe

BNP:

Brain natriuretic peptide

CRT:

Cardiac resynchronization therapy

CS:

Koronarvenensinus

CT:

Computertomographie

EF:

Ejektionsfraktion

EROA:

Effective regurgitant orifice area

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

ICD:

Implantable cardioverter defibrillator

LA:

Linkes Atrium

LV:

Linker Ventrikel

LVEDD:

Linksventrikulärer enddiastolischer Diameter

LVEDV:

Linksventrikuläres enddiastolisches Volumen

LVEF:

Linksventrikuläre Ejektionsfraktion

LVESD:

Linksventrikulärer endsystolischer Diameter

LVOT:

Left ventricular outflow tract

MACE:

Major adverse cardiac event

MI:

Mitralklappeninsuffizienz

MKÖF:

Mitralklappenöffnungsfläche

MRA:

Mineralokortikoidrezeptorantagonist

MRT:

Magnetresonanztomographie

NTproBNP:

N‑terminal prohormone of brain natriuretic peptide

NYHA:

New York Heart Association

PA:

Pulmonalarterie

PISA:

Proximal isovelocity surface area

PVL:

Paravalvuläre Leckage

RA:

Rechtes Atrium

RV:

Rechter Ventrikel

SAM:

Systolic anterior movement

TAPSE:

Tricuspid annular plane systolic excursion

TAVI:

Transcatheter aortic valve implantation

TEE:

Transösophageale Echokardiographie

TI:

Trikuspidalklappeninsuffizienz

TMVI:

Transcatheter mitral valve implantation

TMVR:

Transcatheter mitral valve repair

TSP:

Transseptale Punktion

TTE:

Transthorakale Echokardiographie

ViMAC:

Valve-in-mitral annular calcification

ViR:

Valve-in-ring

ViV:

Valve-in-valve

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Author information

Authors and Affiliations

  1. Klinik III für Innere Medizin, Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Herzzentrum, Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    S. Baldus

  2. Medizinische Klinik und Poliklinik II, Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland

    R. S. v. Bardeleben

  3. Medizinisches Versorgungszentrum, CCB am Agaplesion Bethanien Krankenhaus, Frankfurt am Main, Deutschland

    H. Eggebrecht

  4. Universitätsklinik für Innere Medizin − Kardiologie, Klinikum Oldenburg AöR, Oldenburg, Deutschland

    A. Elsässer

  5. Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland

    J. Hausleiter

  6. Abteilung Kardiologie, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Rostock, Deutschland

    H. Ince

  7. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    M. Kelm

  8. Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Lübeck, Deutschland

    K. H. Kuck

  9. Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg, Hamburg, Deutschland

    E. Lubos & A. Rillig

  10. Medizinische Klinik I – Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen, Deutschland

    H. Nef

  11. Klinik für Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    P. Raake

  12. Klinik für allgemeine und interventionelle Kardiologie und Angiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland

    V. Rudolph

  13. Klinik für Innere Medizin I, Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland

    P. C. Schulze

  14. Paracelsus Harz Klinik Bad Suderode und Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Quedlinburg, Deutschland

    A. Schlitt

  15. Klinikum Mitte, Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bielefeld gem. GmbH, Bielefeld, Deutschland

    C. Stellbrink

  16. Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Johannesstr 9−17, 44137, Dortmund, Deutschland

    H. Möllmann

  17. Ausschuss Zertifizierung der DGK, Deutsche Gesellschaft für Kardiologie, Düsseldorf, Deutschland

    P. Raake

  18. Klinik für Innere Medizin, Kardiologie und konservative Intensivmedizin, Vivantes Klinika Am Urban und im Friedrichshain, Berlin, Deutschland

    H. Ince

Authors
  1. S. Baldus
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  2. R. S. v. Bardeleben
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  3. H. Eggebrecht
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  4. A. Elsässer
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  5. J. Hausleiter
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  6. H. Ince
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  7. M. Kelm
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  8. K. H. Kuck
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  9. E. Lubos
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  10. H. Nef
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  11. P. Raake
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  12. A. Rillig
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  13. V. Rudolph
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  14. P. C. Schulze
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  15. A. Schlitt
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  16. C. Stellbrink
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  17. H. Möllmann
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Corresponding authors

Correspondence to S. Baldus or H. Möllmann.

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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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Baldus, S., v. Bardeleben, R.S., Eggebrecht, H. et al. Interventionelle Therapie von AV-Klappenerkrankungen – Kriterien für die Zertifizierung von Mitralklappenzentren. Kardiologe 14, 339–363 (2020). https://doi.org/10.1007/s12181-020-00409-w

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