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Fortschritte bei implantierbaren mechanischen Kreislaufunterstüzungssystemen

Literaturübersicht und Update

Improvements in implantable mechanical circulatory support systems

Literature overview and update

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Zusammenfassung

VADs („ventricular assist devices“) haben durch rasante Weiterentwicklung in den letzten Jahren v. a. im Bereich der langfristigen permanenten mechanischen Kreislaufunterstützung (MCS) an Bedeutung gewonnen. Sowohl die Implantationszahlen wie auch das Alter der Patienten, welche mit einer solchen Therapie behandelt werden, steigen weltweit an. Durch den fortbestehenden Organspendermangel stellen implantierbare VAD mit einem Einjahresüberleben bis zu 86% eine adäquate temporäre Alternative zur Herztransplantation (HTx) dar. In Fällen, bei welchen eine HTx kontraindiziert ist, bleibt die VAD-Implantation als einzige Option, um das langfristige Überleben des Patienten zu sichern. Patientenselektion, prä-, intra- und postoperative Versorgung sowie der Zeitpunkt der VAD-Implantation bestimmen den Erfolg dieser Therapie maßgeblich. Obwohl die Überbrückung zur HTx („bridge to transplantation“, BTT) nach wie vor das Ziel für die meisten Patienten ist, steigt der prozentuale Anteil an permanenten VAD stark an („bridge to destination“, BTD). Eine Explantation eines VAD-Systems als sog. „bridge to recovery“ (BTR) kommt nur für wenige Patienten in Frage, stellt aber einen sehr speziellen Teil dieser Therapieform dar.

Abstract

In recent years, ventricular assist devices (VAD) supporting the left (LVAD), the right (RVAD) or both ventricles (BVAD) have rapidly emerged as the standard of care for advanced heart failure patients. Both the numbers and ages of patients in which they are used are rising worldwide, especially when used as a permanent support (bridge to destination, BTD). Due to the continuing lack of donor organs, these devices now represent a viable alternative to bridge patients to transplantation (BTT), with a 1-year survival rate of 86%. BTD, especially in long-term support, might be a valid, and the sole, option for those patients in whom heart transplantation is contraindicated. Patient selection, pre- and intra-operative preparation, as well as the timing of VAD implantation are important factors critical to successful circulatory support. While BTT remains the goal in the majority of patients, the number of permanent VADs (i. e. BTD) is rising significantly. Although explantation of a VAD system as a bridge to recovery (BTR) can be considered in only a small number of patients, it represents a very special part of this therapy modality.

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Authors and Affiliations

  1. Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    T. Krabatsch,  M. Schweiger, A. Stepanenko, T. Drews, E. Potapov, M. Pasic, Y. Weng, M. Huebler & R. Hetzer

  2. Universitätsklinik für Chirurgie, Medizinische Universität Graz, Graz, Österreich

    M. Schweiger

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  1. T. Krabatsch
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  2. M. Schweiger
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  3. A. Stepanenko
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  4. T. Drews
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  5. E. Potapov
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  6. M. Pasic
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  7. Y. Weng
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  8. M. Huebler
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  9. R. Hetzer
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Correspondence to M. Schweiger.

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* Die zwei ersten Autoren teilen sich die Erstautorenschaft

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Krabatsch, T., Schweiger, M., Stepanenko, A. et al. Fortschritte bei implantierbaren mechanischen Kreislaufunterstüzungssystemen. Herz 36, 622–629 (2011). https://doi.org/10.1007/s00059-011-3509-5

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