Renker Matthias, Charitos Efstratios I, Choi Yeong-Hoon, Sossalla Samuel
Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
Abteilung Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim, Deutschland.
Inn Med (Heidelb). 2024 May;65(5):431-438. doi: 10.1007/s00108-024-01699-y. Epub 2024 Apr 18.
The pathophysiology of aortic valve diseases is of predominantly degenerative nature, characterized by calcific aortic valve stenosis, which is associated with a reduction in prognosis. The prevalence of aortic valve insufficiency also increases with advancing age. Timely causal treatment is crucial in the management of aortic valve diseases. Following the indication for intervention, the heart team plays a central role in evaluating the results and making therapeutic decisions that consider the patient's preferences. In the assessment of treatment options, considerations regarding the long-term perspective are particularly crucial, especially in younger patients. The most common therapeutic approach for aortic valve diseases is the introduction of a new valve prosthesis. In the majority of cases, this is now achieved through catheter-based implantation of a bioprosthetic heart valve, known as transcatheter aortic valve implantation (TAVI). Open surgical aortic valve replacement (AVR) is favored in younger patients with low surgical risk or in the case that TAVI is not feasible. In AVR, both biological and the longest-lasting mechanical prosthesis types are used. Surgical repair techniques are primarily applied in cases of aortic valve regurgitation. Notably, TAVI, as well as surgical procedures for the treatment of aortic valve diseases, have undergone significant advancements in recent years, including expanded indications for TAVI and, on the surgical side, in particular the development of minimally invasive surgical techniques.
主动脉瓣疾病的病理生理学主要具有退行性本质,其特征为钙化性主动脉瓣狭窄,这与预后降低相关。主动脉瓣关闭不全的患病率也随年龄增长而增加。及时的病因治疗在主动脉瓣疾病的管理中至关重要。在有干预指征后,心脏团队在评估结果和做出考虑患者偏好的治疗决策方面发挥核心作用。在评估治疗方案时,考虑长期观点尤为关键,特别是在年轻患者中。主动脉瓣疾病最常见的治疗方法是植入新的瓣膜假体。在大多数情况下,现在这是通过基于导管的生物人工心脏瓣膜植入来实现的,即经导管主动脉瓣植入术(TAVI)。对于手术风险低的年轻患者或TAVI不可行的情况,开放式外科主动脉瓣置换术(AVR)更受青睐。在AVR中,生物假体和使用时间最长的机械假体类型都会用到。手术修复技术主要应用于主动脉瓣反流的病例。值得注意的是,近年来TAVI以及治疗主动脉瓣疾病的外科手术都取得了重大进展,包括TAVI适应证的扩大,以及在外科方面,特别是微创外科技术的发展。