Kathetergestützter Aortenklappenersatz: Alternative zur offenen Chirurgie bei Hochrisikopatienten

Prosthetic aortic valve replacement with extracorporeal circulation is the therapy of choice for high-grade symptomatic aortic stenosis; the mean risk of the procedure is 2–5 %. Due to age and comorbidities, a number of patients can be at a far higher risk. Meanwhile, catheter-based valve replacement procedures constitute an alternative for these patients by minimizing the operative risk. Between 7/2007 and 11/2008 a total of 182 patients with a mean age of 81.1 years were treated. According to the logistic Euroscore the predicted operative risk was at a mean of 22.5 % and according to STS score at 23.5 %. A total of 145 CoreValve and 37 Edwards-Sapien prostheses were implanted; transarterial access was preferred in 79 % of the patients. The 30-day mortality in the total collective was 10.9 %. After one year, over 78 % of patients with transarterial access and 56 % of patients with transapical access were still alive. Substantial complications were AV block requiring pacemaker implantation (21 %) and peripheral vascular complications (20 %). Catheter-based aortic valve replacement could be established as a routine alternative procedure for patients with increased operative risk. Mortality is satisfactory, given the score-predicted risk. Further improvement of results can be expected through optimization of procedural management and technical modifications of valves and catheters.