[Management of patients with heart valve diseases in 2008. What has changed in the last three decades?].

In Central Europe, the vast majority of patients with valvar heart disease today suffer from degenerative aortic valve stenosis or mitral regurgitation. Due to the aging population, the prevalence of both diseases is rapidly increasing. Despite older age at the time of intervention and more co-morbidities, perioperative mortality has been constantly low (about 3.5 % in Germany). Clinical symptoms reported by patients are often inappropriate to chose the optimal time for intervention. Myocardial contractility reserve is yet the most appropriate measure to assess myocardial adaption to the chronic pressure and/or volume overload. Awaiting myocardial maladaption is hampered by a significant worsening in prognosis. This is especially true for mitral regurgitation, where imaging techniques regularly fail to assess LV pump function due to the low left ventricular impedance. For patients with valvar heart disease requiring therapy with vitamin K antagonists, stability of oral anticoagulation therapy is essential to avoid thromboembolic as well as bleeding complications. For the majority of these patients, a target INR of 2.5 is optimal. INR point of care self management results in a more than 30 % reduction of adverse events.