Die Nachsorge von Patienten nach MitraClip®-Implantation

TY - JOUR

T1 - Die Nachsorge von Patienten nach MitraClip®-Implantation

AU - Schlitt, A

AU - Lubos, E

AU - Guha, M

AU - Hegeler-Molkewehrum, C

AU - Sudau, M

AU - Schmidt, H

PY - 2017/4

Y1 - 2017/4

N2 - Many patients with moderate to severe mitral regurgitation cannot be subjected to surgical therapy due to their multimorbidity. For these patients, MitraClip® implantation is a therapeutic alternative.The aim of this article is to present recommendations for treatment after a MitraClip® procedure. For this purpose, a selective literature review has been carried out based on the current literature, notably on national and international guidelines.After a MitraClip® procedure, rehabilitation is indicated because of the underlying heart failure as well as the treatment of a heart valve. Here, optimization of drug therapy, implementation of standardized heart failure training, the initiation of strength and endurance training and psychosocial support are initiated. Patients will be briefed on endocarditis prophylaxis lasting for at least six months. Furthermore, according to current guidelines, treatment with ACE inhibitors, beta-blockers and aldosterone antagonists are optimized. A special feature is anticoagulation, which is currently empirically accounted for and performed in sinus rhythm typically for four weeks of dual antiplatelet therapy (aspirin and clopidogrel) followed by a monotherapy with aspirin. In atrial fibrillation, lifelong oral anticoagulation is indicated combined with a platelet aggregation inhibitor for four weeks.In particular, echocardiographic control in the rehabilitation clinic and by cardiologists has to be focused on a residual atrial septal defect, the transmitral gradient and a residual mitral regurgitation.

AB - Many patients with moderate to severe mitral regurgitation cannot be subjected to surgical therapy due to their multimorbidity. For these patients, MitraClip® implantation is a therapeutic alternative.The aim of this article is to present recommendations for treatment after a MitraClip® procedure. For this purpose, a selective literature review has been carried out based on the current literature, notably on national and international guidelines.After a MitraClip® procedure, rehabilitation is indicated because of the underlying heart failure as well as the treatment of a heart valve. Here, optimization of drug therapy, implementation of standardized heart failure training, the initiation of strength and endurance training and psychosocial support are initiated. Patients will be briefed on endocarditis prophylaxis lasting for at least six months. Furthermore, according to current guidelines, treatment with ACE inhibitors, beta-blockers and aldosterone antagonists are optimized. A special feature is anticoagulation, which is currently empirically accounted for and performed in sinus rhythm typically for four weeks of dual antiplatelet therapy (aspirin and clopidogrel) followed by a monotherapy with aspirin. In atrial fibrillation, lifelong oral anticoagulation is indicated combined with a platelet aggregation inhibitor for four weeks.In particular, echocardiographic control in the rehabilitation clinic and by cardiologists has to be focused on a residual atrial septal defect, the transmitral gradient and a residual mitral regurgitation.

KW - Aftercare/methods

KW - Cardiac Catheterization/adverse effects

KW - Endocarditis/etiology

KW - Evidence-Based Medicine

KW - Heart Valve Prosthesis/adverse effects

KW - Heart Valve Prosthesis Implantation/adverse effects

KW - Humans

KW - Mitral Valve Annuloplasty/instrumentation

KW - Mitral Valve Insufficiency/complications

KW - Thrombosis/etiology

KW - Treatment Outcome

U2 - 10.1007/s00059-016-4448-y

DO - 10.1007/s00059-016-4448-y

M3 - SCORING: Review

C2 - 27349588

VL - 42

SP - 176

EP - 185

JO - HERZ

JF - HERZ

SN - 0340-9937

IS - 2

ER -