Nettersheim Felix S, Baldus Stephan
Klinik III für Innere Medizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Germany.
Herz. 2025 Apr;50(2):103-112. doi: 10.1007/s00059-025-05299-w. Epub 2025 Mar 4.
The management of valvular heart disease has undergone a remarkable transformation over the past two decades, which was driven by the advent of catheter-based treatment methods. Whereas medical therapy was the only available treatment option for many older patients deemed unsuitable for conventional surgery until the early 2000s, a wide range of interventional therapies is now available. Transcatheter aortic valve replacement and mitral valve transcatheter edge-to-edge repair evidently provide prognostic advantages over medical therapy for inoperable patients with severe aortic stenosis and secondary mitral regurgitation, and they have been demonstrated to be non-inferior to conventional surgery in certain operable patient groups. Although catheter-based therapies of aortic and tricuspid regurgitation have not yet been proven to provide prognostic benefits, these approaches enable substantial and sustainable improvements in symptoms as well as quality of life while demonstrating a favorable safety profile. Given the multitude of available options for the treatment of valvular heart diseases, determining the appropriate indication and selecting the optimal therapeutic approach often pose significant challenges. This review article highlights the latest advancements in valvular heart disease management and explores the patient-centered application of available therapies within the framework of an approach toward precision medicine.
在过去二十年中,瓣膜性心脏病的治疗发生了显著变革,这一变革是由基于导管的治疗方法的出现所推动的。直到21世纪初,对于许多被认为不适合传统手术的老年患者来说,药物治疗是唯一可用的治疗选择,而现在有了广泛的介入治疗方法。经导管主动脉瓣置换术和二尖瓣经导管缘对缘修复术对于重度主动脉瓣狭窄和继发性二尖瓣反流的无法手术的患者而言,显然比药物治疗具有预后优势,并且在某些可手术的患者群体中已被证明不劣于传统手术。虽然基于导管的主动脉瓣反流和三尖瓣反流治疗方法尚未被证明确实能带来预后益处,但这些方法能够显著且持续地改善症状和生活质量,同时显示出良好的安全性。鉴于瓣膜性心脏病的治疗有多种可用选择,确定合适的适应症并选择最佳治疗方法往往面临重大挑战。这篇综述文章重点介绍了瓣膜性心脏病治疗的最新进展,并在精准医学方法的框架内探讨了以患者为中心的可用治疗方法的应用。