Welche Herzklappe für welchen Patienten – Selektion der Klappen interventionell und konventionell

Abstract

Prosthesis choice for aortic or mitral valve replacement should be individualized and discussed by an interdisciplinary heart team and the informed patient. Taking into account the age, comorbidities, compliance and lifestyle of the patient, the heart team should evaluate if a patient can undergo mechanical or biological conventional heart valve replacement, or if a catheter based procedure should be offered. A mechanical valve is indicated if the patient already has a mechanical valve, or if there is an increased risk for degeneration of a biological prosthesis, and if there are no contraindications for lifelong anticoagulation. A biological valve is indicated if good quality anticoaguloation is unlikely, bleeding risk is increased, or previous mechanical valve thrombosis has occurred. A bioprosthesis should also be considered in young women contemplating pregnancy. Transcatheter valve procedures (TAVI) are an alternative to the conventional procedure in patients with high surgical risk. The experience of the heart team is of utmost importance for the assessment and decision making. The results of ongoing large randomized trials will further specify the indications for TAVI.