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Positionspapier zur kathetergeführten Aortenklappenintervention

Position paper on catheter-based aortic valve surgery

  • Positionspapier
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

 

Aufgrund der zunehmenden Verbreitung der kathetergeführten Aortenklappenimplantation (Kath-AKE) wird im Folgenden die Position der DGK und der DGHTG zu dieser Intervention dargelegt.

Zur Indikationsstellung

Diese sollte unbedingt in einer gemeinsamen Konferenz zwischen Kardiologen und Herzchirurgen erfolgen. Kath-AKE’s sind gegenwärtig mit einer ca. 10% 30-Tage-Mortalität verbunden und sind deswegen nur indiziert bei: inoperablen Patienten, Patienten >75 Jahre mit einer STS >10 ≤20 oder eines Euroscore >20 ≤40. Bei Patienten mit höherem STS oder Euroscore bzw. bei Patienten mit einer Lebenserwartung <1 Jahr, Patienten mit Aorteninsuffizienz >II. Grades oder Klappendurchmesser <18 >27 mm ist der Eingriff eher nicht oder kontraindiziert (Empfehlungsgrad IIb, III).

Zur Durchführung

Der Eingriff sollte in Zusammenarbeit von Kardiologen und Herzchirurgen nach einem ausreichendem Training durchgeführt werden im Bereich einer Herzkatheteranlage oder in einem Hybrid-OP, da das Management von Komplikationen die sofortige fachliche Kompetenz beider Fachdisziplinen erfordert. Alle Eingriffe einschließlich Aortenballonvalvuloplastien, die nur palliativ durchgeführt werden, sollen in das „Aortenklappenregister“ eingegeben werden (http://www.herzinfarktforschung.de/Projekte/RegisterN/Aortenklappenregister.html).

Abstract

 

Due to the increasing number of percutaneous aortic valve replacements carried out, particularly in Germany, the position adopted by the German Cardiac Society (DGK) and the German Society of Thorax, Heart and Vessel Surgery (DGTHG) is set out below:

Indication

In a joint meeting between cardiologists and heart surgeons, the indications for a percutaneous aortic valve replacement (PAVR) should be reviewed. At present, PAVR seems to be indicated in patients who cannot be operated on (due to malformation of the thorax, porcelain aorta, etc.) or in patients older than 75 years in combination with an STS (Society of Thoracic Surgeons) score of more than 10 but no more than 20, or a logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) of more than 20 but no more than 40. PAVR is not recommended or is contraindicated (recommendation level II b, III) in patients with a higher STS score or EuroSCORE, patients with a life expectancy of less than 1 year, patients with more than second-degree aortic regurgitation, or patients with a valve diameter of <18 or >27 mm. At present, the average 30-day mortality rate following PAVR is approximately 10%.

Procedure

The procedure should be performed by cardiologists together with heart surgeons in either a hybrid operation theater or in a cardiac cath lab after an intense training program. The latter management of complications requires the experience of both disciplines. All procedures, including aortic balloon valvuloplasty, are only performed as palliative procedures should be registered in the aortic valve registry (http://www.herzinfarktforschung.de/Projekte/RegisterN/Aortenklappenregister.html).

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Notes

  1. Der Einsatz der Edwards-Sapien-Klappe in Pulmonalposition, Mitralposition oder in degenerierten Bioprothesen ist nicht zertifiziert und entspricht einem sog. „off-label-use“.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Hans R. Figulla: Beratervertrag mit JenaValve, Patente und Beteiligung bei JenaValve. Jochen Cremer: keine. Thomas Walther: Vortragshonorare für Fachvorträge Edwards Lifesciences. Ulrich Gerckens: Vortragshonorare für Vorträge zum Thema Klappenimplantation und Symposien. Raimund Erbel: keine. Ady Osterspey: keine. Ralf Zahn: keine.

Authors
  1. H.R. Figulla
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  2. J. Cremer
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  3. T. Walther
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  4. U. Gerckens
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  5. R. Erbel
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  6. A. Osterspey
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  7. R. Zahn
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Additional information

__ ____

Prof. Dr. H.R. Figulla ist federführender Autor dieses Positionspapiers.

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Figulla, H., Cremer, J., Walther, T. et al. Positionspapier zur kathetergeführten Aortenklappenintervention. Kardiologe 3, 199–206 (2009). https://doi.org/10.1007/s12181-009-0183-4

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  • DOI: https://doi.org/10.1007/s12181-009-0183-4

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