Mangner N, Schuler G
Klinik für Innere Medizin/ Kardiologie, Herzzentrum Leipzig - Universitätsklinik, Strümpellstr. 39, 04289, Leipzig, Deutschland.
Herz. 2013 Dec;38(8):828-37. doi: 10.1007/s00059-013-3975-z.
In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least, in patients with aortic bioprostheses the use of low-dose aspirin is now favored for a 3-month postoperative period.
2012年，欧洲心脏病学会（ESC）和欧洲心胸外科学会（EACTS）联合发布了新版“心脏瓣膜病管理指南（2012版）”。这些指南强调，心脏瓣膜病患者的决策理想情况下应由在心脏瓣膜病方面具有专业知识的“心脏团队”进行。在主动脉瓣反流中，主动脉根部病变很常见，对于马凡综合征患者，当升主动脉最大直径≥50毫米时建议进行手术，而对于有病情进展危险因素的患者，干预阈值应更低。关于主动脉瓣狭窄，经导管主动脉瓣植入术（TAVI）应仅在有现场心脏手术且有“心脏团队”可评估患者风险的医院进行。TAVI手术适用于经“心脏团队”判断不适合手术但预期寿命足够的重度有症状主动脉瓣狭窄患者。对于根据“心脏团队”评估的个体风险状况属于高危的重度有症状主动脉瓣狭窄患者，应考虑进行该手术。此外，还讨论了射血分数正常的低流量 - 低梯度主动脉瓣狭窄以及无症状重度主动脉瓣狭窄这一难题和主动脉瓣置换的指征。关于二尖瓣反流，当预计瓣膜修复持久时，应作为首选技术。讨论了无症状二尖瓣反流以及使用缘对缘技术进行经皮二尖瓣修复作为高危患者替代方案的话题。不应忽视三尖瓣疾病，在进行左侧瓣膜手术时，如果存在明显的瓣环扩张且有轻度至中度继发性反流，应考虑进行三尖瓣手术。最后但同样重要的是，对于植入主动脉生物瓣膜的患者，目前倾向于在术后3个月使用低剂量阿司匹林。
