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Koronare Herzerkrankung

Interventionelle und operative Therapiemöglichkeiten nach Herzstillstand

Coronary artery disease

Interventional and operative therapeutic options after cardiac arrest

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Zusammenfassung

Die koronare Herzkrankheit (KHK) stellt eine häufige strukturelle Ursache für einen Herzstillstand im höheren Alter dar, während hierfür beim jungen Erwachsenen eher Kardiomyopathien oder Ionenkanalerkrankungen ursächlich sind. Strukturelle Herzerkrankungen sind bei etwa der Hälfte der Patienten mit Herzstillstand vorbekannt. Die vorliegende Übersichtsarbeit stellt aktuelle interventionelle und operative Therapiemöglichkeiten nach einem Herzstillstand dar. Schwerpunkte liegen hierbei auf der Darstellung der Zusammenhänge zwischen epidemiologischen Daten zur Inzidenz von malignen Herzrhythmusstörungen als Ursache für einen Herzstillstand in Abhängigkeit des Vorhandenseins einer KHK. Zum anderen wird der mögliche Nutzen einer möglichst frühen koronaren Revaskularisation und einer umgehenden kompletten Revaskularisation gegenüber der alleinigen Therapie der sog. „culprit lesion“ aufgezeigt. Abschließend werden die Vorteile invasiver Therapiemaßnahmen, wie etwa des zielgerichteten Temperaturmanagements und mechanischer Herzunterstützungssysteme für Patienten nach erfolgreich überstandener kardiopulmonaler Reanimation beschrieben. Letztere umfassen die sog. intraaortale Gegenpulsation (IABP) und Möglichkeiten der extrakorporalen Herzunterstützung („extracorporeal life support“, ECSL) zur peripheren und zentralen Unterstützung der rechten und linken Herzkammer.

Abstract

Coronary artery disease (CAD) represents a common structural cause for developing cardiac arrest in older patients, whereas in young adults cardiac arrest is more often caused by cardiomyopathies and cardiac channelopathies. A structural heart disease is known in almost 50% of patients prior to cardiac arrest. The present review outlines current interventional and operative therapeutic options for patients surviving cardiac arrest. The focus is on associations between epidemiological data on the incidence of malignant arrhythmias causing cardiac arrest depending on the presence or absence of CAD. Furthermore, the potential benefits of an early coronary revascularization as well as of a prompt complete coronary revascularization compared to the individual treatment of the so-called culprit lesion only are described. Finally, the advantages of invasive therapies for patients surviving cardiac arrest, such as targeted temperature management and mechanical cardiac assist devices, are elucidated. Cardiac assist devices comprise the use of the intra-aortic balloon pump (IABP) and devices for extracorporeal life support (ECLS) for peripheral and central support of the right and left heart chambers.

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Danksagung

Wir danken den Firmen Abiomed Europe (Aachen, Germany), Cardiac Assisst, Inc. (Pittsburgh, USA), AVIDAL Group (Berlin, Germany) und MAQUET GETINGE GROUP (Rastatt, Germany) für die freundliche Bereitstellung der Abbildungen zu den Assist-Devices.

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  1. I. Medizinische Klinik, Universitätsmedizin Mannheim (UMM), Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    M. Behnes, M. Borggrefe & I. Akin

  2. Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Bad Krozingen, Deutschland

    K. Mashayekhi

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  1. M. Behnes
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Correspondence to M. Behnes.

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M. Behnes, K. Mashayekhi, M. Borggrefe und I. Akin geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Behnes, M., Mashayekhi, K., Borggrefe, M. et al. Koronare Herzerkrankung. Herz 42, 138–150 (2017). https://doi.org/10.1007/s00059-017-4546-5

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