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Intensivbehandlung von Kranken mit Linksherzersatz

Intensive care treatment of patients with left ventricular assist devices

  • Leitthema
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Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Der Linksherzersatz durch ein Unterstützungssystem [„left ventricular assist device“ (LVAD)] ist, abgesehen von der Herztransplantation, die einzig etablierte chirurgische Behandlung des therapierefraktären Endstadiums der Linksherzinsuffizienz. Das individuelle intensivmedizinische Management dieser Patienten ist vom Aufnahmegrund abhängig und bedarf einer Vorstellung von der spezifischen Hämodynamik und den Eigenheiten der derzeit am häufigsten implantierten Kunstherzen mit nichtpulsatilem Flussmuster. Hierzu gehören Kenntnisse des hämodynamischen Monitorings, der Pumpenspezifika, des Managements von Antikoagulation und Hämostase sowie der Bewältigung von Problemen wie Rechtsherzversagen, Aortenklappeninsuffizienz und Infektionen. Die Behandlung eines bewusstlosen LVAD-Patienten stellt eine klinische Herausforderung dar, die versierte Kenntnisse in der transthorakalen und transösophagealen Echokardiographie, eine gezielte Labordiagnostik und pathophysiologisches Wissen zur differenzialdiagnostischen Abklärung erfordert. Unumgänglich sind zudem eine professionelle, interdisziplinäre Zusammenarbeit sowie der Austausch aktueller kritischer Informationen.

Abstract

Apart from heart transplantation, implantation of a left ventricular assist device (LVAD) is the only established surgical treatment for therapy-refractory terminal left heart failure, The specific intensive care unit (ICU) management of these patients depends on the reason for the ICU admission and requires understanding of the characteristic hemodynamics of non-pulsatile LVADs as well as of the inherent problems. Knowledge about the specific features in hemodynamic monitoring, understanding of pump characteristics, management of anticoagulation and hemostasis and the handling of problems, such as right heart failure, aortic valve insufficiency and infections is essential. The management of unconscious LVAD patients can be challenging. It requires a sophisticated transthoracic and transesophageal echocardiography (TTE/TEE) examination, targeted laboratory diagnostics and consideration of possible alternative diagnoses. Professional interdisciplinary cooperation and exchange of current knowledge is crucial.

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Authors and Affiliations

  1. Klinische Abteilung für Herz-, Thorax-, Gefäßchirurgische Anästhesie und Intensivmedizin, Universitätsklinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Währinger Gürtel 18–20, 1090, Wien, Österreich

    B. Steinlechner, Arno Schiferer, Nikolaus Heinrich, Angela Rajek, Martin Dworschak & Michael Hiesmayr

  2. Klinische Abteilung für Herzchirurgie, Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, 1090 Wien, Österreich

    Daniel Zimpfer & Thomas Schlöglhofer

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Correspondence to B. Steinlechner.

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B. Steinlechner, D. Zimpfer, A. Schiferer, N. Heinrich, T. Schlöglhofer, A. Rajek, M. Dworschak und M. Hiesmayr geben an, dass kein Interessenkonflikt besteht.

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Steinlechner, B., Zimpfer, D., Schiferer, A. et al. Intensivbehandlung von Kranken mit Linksherzersatz. Med Klin Intensivmed Notfmed 110, 421–430 (2015). https://doi.org/10.1007/s00063-015-0063-6

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  • DOI: https://doi.org/10.1007/s00063-015-0063-6

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