Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Aug 2022
[Mitral valve: When conservative, when surgical, when interventional therapy?]
The management of severe symptomatic mitral regurgitation is in contrast to the aortic-valve-intervention more challenging due to the complex mitral-valve anatomy. In primary mitral regurgitation surgical therapy is recommended, whereas there are various therapeutic options in secondary mitral regurgitation. Besides the established mitral-valve Transcatheter Edge-to-Edge-Repair (M-TEER) and the interventional annuloplasty - devices dynamic developments have recently been made in the field of Transcatheter Mitral Valve Replacement-therapy (TMVR). This article surveys the current recommendations and available therapeutic options in mitral regurgitation.
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Dtsch. Med. Wochenschr. · Aug 2022
[Follow up Management after Transcatheter Aortic Valve Implantation].
Transcatheter aortic valve implantation (TAVI) has emerged as the gold standard therapy for patients with severe aortic stenosis with a high operative risk or older than 75 years. As these patients usually exhibit several comorbidities, not only the preinterventional and periinterventional management are of interest, but also the postinterventional care plays an incremental role in order to prevent short and long term complications having an enormous influence on morbidity and mortality. Therefore, a close clinical observation by the primary care physician and primary cardiologist is essential for the patient's outcome. ⋯ Next to the endocarditis prophylaxis before specific dental procedures, the antithrombotic regimen plays a key role in the follow up management after TAVI. On the one hand, antithrombotic therapy reduces thromboembolic complications, on the other hand they might increase the bleeding risk. An optimal antithrombotic treatment strategy challenges clinicians as patient-specific risk factors and comorbidities (e. g., age, atrial fibrillation, coronary artery disease) must be considered and current data still leave some uncertainties.
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Dtsch. Med. Wochenschr. · Aug 2022
[Aortic valve disease: Diagnostics and choice of treatment modality].
Aortic valve disease, especially aortic valve stenosis, is one of the most common acquired valve diseases and is associated with increased mortality and morbidity. Due to the rising age of the population, the prevalence of aortic valve stenosis has increased sharply in recent years. For many years, surgical aortic valve replacement was the only available therapy beside the conservative approach. ⋯ While this therapy was initially limited to inoperable and high-risk patients, the indication has been increasingly extended to younger patients with lower surgical risk over the past years. However, choosing the optimal therapy modality and determining the ideal timing of treatment can often be challenging in clinical practice. The aim of this article is to provide an overview of the different therapy modalities, the decision-making process and current therapy guidelines.
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Cancer has become a leading cause of death among patients with metabolic syndrome (MetS). The more components of MetS a patient has, the higher his risk of cancer. ⋯ Intentional long-term weight loss reduces the excess cancer risk of obese MetS-patients. Both a low-risk lifestyle and cancer screening are effective and decrease the burden of cancer.
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Dtsch. Med. Wochenschr. · Aug 2022
[Specific characteristics of geriatric rehabilitation: target groups, offers, access].
Geriatric rehabilitation is an interdisciplinary offer of rehabilitation services for elderly persons who often have several impairments and, in some cases, an already existing need for nursing care. It aims at maintaining their self-determined participation in everyday life to the greatest possible extent as well as at avoiding or reducing their needs for nursing care. Characteristic features of geriatric patients are high vulnerability due to an age-related reduction of reserves and often multiple chronic diseases. ⋯ Especially, mobile rehabilitation that is directly performed at the patient's home constitutes a particularly suitable rehabilitation setting mainly for persons who will still need nursery care despite reaching their rehabilitation targets. But this kind of rehabilitation care is still little known. The article provides decision-making aids to physicians in hospitals and doctor's offices as well as information on how to gain access to geriatric-rehabilitative care services, including new regulations to facilitate this access, which are planned for 01 July 2022.