Skip to main content
SpringerLink
Log in

Indikationsstellung und Therapieziele der mechanischen Kreislaufunterstützung

Vormarsch der Maschinen?

Indications and strategies in mechanical circulatory support

Rise of the machines?

  • Übersichten
  • Published:
Medizinische Klinik - Intensivmedizin und Notfallmedizin Aims and scope Submit manuscript

Zusammenfassung

Die terminale Herzinsuffizienz ist eine ernsthafte Herausforderung der modernen Medizin. Die Zahl der betroffenen Patienten wächst kontinuierlich in der westlichen Welt und übersteigt aktuell bei weitem die Zahl der potenziell verfügbaren Spenderherzen. Damit wird die mechanische Kreislaufunterstützung zunehmend zum etablierten Bestandteil der chirurgischen Therapie nach Ausschöpfung der konservativen Therapiemöglichkeiten. Bereits jetzt ist ein weltweiter Anstieg der Kunstherzimplantationen zu verzeichnen bei insgesamt guten Überlebensraten der behandelten Patienten. Die richtige Patientenselektion, die korrekte Indikationsstellung sowie der optimale Zeitpunkt der Implantation garantieren dabei das gute Outcome der Patienten mit terminaler Herzinsuffizienz. Diese Übersichtsarbeit systematisiert die möglichen Indikationen und Therapieziele für diverse Patientengruppen und gibt einen Überblick über die aktuell verfügbaren Kreislaufunterstützungssysteme.

Abstract

Terminal heart failure is an emerging problem with a continuously growing number of diseased patients worldwide. Because of the limited number of donor hearts, mechanical circulatory support is increasingly becoming an integral part of surgical treatment for end-stage heart failure, especially in patients deemed for destination therapy. Accurate patient selection, appropriate indication, and the optimal implantation time point guarantee a good outcome for these patients. This review article gives a systematic overview of the possible indication settings and treatment strategies for various patient groups in need of mechanical circulatory support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Anderson MB, Goldstein J, Milano C et al (2015) Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 34:1549–1560

    Article  Google Scholar 

  2. Beurtheret S, Mordant P, Paoletti X et al (2013) Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). Eur Heart J 34:112–120

    Article  Google Scholar 

  3. Bruckner BA, Stetson SJ, Perez-Verdia A et al (2001) Regression of fibrosis and hypertrophy in failing myocardium following mechanical circulatory support. J Heart Lung Transplant 20:457–464

    Article  CAS  Google Scholar 

  4. Bull DA, Reid BB, Selzman CH et al (2010) The impact of bridge-to-transplant ventricular assist device support on survival after cardiac transplantation. J Thorac Cardiovasc Surg 140:169–173

    Article  Google Scholar 

  5. Cheung AW, White CW, Davis MK, Freed DH (2014) Short-term mechanical circulatory support for recovery from acute right ventricular failure: clinical outcomes. J Heart Lung Transplant 33:794–799

    Article  Google Scholar 

  6. Dipla K, Mattiello JA, Jeevanandam V et al (1998) Myocyte recovery after mechanical circulatory support in humans with end-stage heart failure. Circulation 97:2316–2322

    Article  CAS  Google Scholar 

  7. Dor V (2004) Surgical remodeling of left ventricle. Surg Clin North Am 84:27–43

    Article  Google Scholar 

  8. Ertl G, Störk S, Börste R (2016) Competence Network Heart Failure (CNHF). Together against heart failure. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 59:506–513

    Article  Google Scholar 

  9. Frazier OH, Myers TJ (1999) Left ventricular assist system as a bridge to myocardial recovery. Ann Thorac Surg 68:734–741

    Article  CAS  Google Scholar 

  10. Haneya A, Philipp A, Puehler T et al (2012) Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation. Eur J Cardiothorac Surg 41:219–223

    Article  Google Scholar 

  11. John R, Liao K, Kamdar F et al (2010) Effects on pre- and posttransplant pulmonary hemodynamics in patients with continuous-flow left ventricular assist devices. J Thorac Cardiovasc Surg 140:447–452

    Article  Google Scholar 

  12. Kirklin JK, Cantor R, Mohacsi P et al (2016) First Annual IMACS Report: A global International Society for Heart and Lung Transplantation Registry for Mechanical Circulatory Support. J Heart Lung Transplant 35:407–412

    Article  Google Scholar 

  13. Kirklin JK, Naftel DC, Kormos RL et al (2011) Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant 30:115–123

    Article  Google Scholar 

  14. Küçüker SA, Stetson SJ, Becker KA et al (2004) Evidence of improved right ventricular structure after LVAD support in patients with end-stage cardiomyopathy. J Heart Lung Transplant 23:28–35

    Article  Google Scholar 

  15. Lund LH, Edwards LB, Dipchand AI et al (2016) The registry of the International Society for Heart and Lung Transplantation: thirty-third adult heart transplantation report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transplant 35:1158–1169

    Article  Google Scholar 

  16. Matthews JC, Koelling TM, Pagani FD, Aaronson KD (2008) The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol 51:2163–2172

    Article  Google Scholar 

  17. Ouweneel DM, Eriksen E, Seyfarth M, Henriques JPS (2017) Percutaneous mechanical circulatory support versus intra-aortic balloon pump for treating Cardiogenic shock: meta-analysis. J Am Coll Cardiol 69:358–360

    Article  Google Scholar 

  18. Oz MC, Rose EA, Levin HR (1995) Selection criteria for placement of left ventricular assist devices. Am Heart J 129:173–177

    Article  CAS  Google Scholar 

  19. Patel ND, Weiss ES, Schaffer J et al (2008) Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices. Ann Thorac Surg 86:832–840 (discussion 832–40)

    Article  Google Scholar 

  20. Rose EA, Gelijns AC, Moskowitz AJ et al (2001) Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 345:1435–1443

    Article  CAS  Google Scholar 

  21. Russell SD, Rogers JG, Milano CA et al (2009) Renal and hepatic function improve in advanced heart failure patients during continuous-flow support with the HeartMate II left ventricular assist device. Circulation 120:2352–2357

    Article  Google Scholar 

  22. Schmitto JD, Zimpfer D, Fiane AE et al (2016) Long-term support of patients receiving a left ventricular assist device for advanced heart failure: a follow-up analysis of the Registry to Evaluate the HeartWare Left Ventricular Assist System. Eur J Cardiothorac Surg 50:834–838

    Article  Google Scholar 

  23. Taggart P, Sutton P, John R et al (1992) Monophasic action potential recordings during acute changes in ventricular loading induced by the Valsalva manoeuvre. Br Heart J 67:221–229

    Article  CAS  Google Scholar 

  24. Takayama H, Naka Y, Kodali SK et al (2012) A novel approach to percutaneous right-ventricular mechanical support. Eur J Cardiothorac Surg 41:423–426

    Article  Google Scholar 

  25. Westaby S (2000) Non-transplant surgery for heart failure. Heart 83:603–610

    Article  CAS  Google Scholar 

  26. Williams MR, Oz MC (2001) Indications and patient selection for mechanical ventricular assistance. Ann Thorac Surg 71:86–91

    Article  Google Scholar 

  27. Writing Group Members, Mozaffarian D, Benjamin EJ et al (2016) Executive summary: heart disease and stroke statistics – 2016 update: a report from the American heart association. Circulation 133:447–454

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377, München, Deutschland

    A. Dashkevich PhD, S. Michel & C. Hagl

Authors
  1. A. Dashkevich PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Hagl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Dashkevich PhD.

Ethics declarations

Interessenkonflikt

A. Dashkevich, S. Michel und C. Hagl geben an, dass kein Interessenkonflikt besteht.

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

Additional information

Redaktion

M. Buerke, Siegen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dashkevich, A., Michel, S. & Hagl, C. Indikationsstellung und Therapieziele der mechanischen Kreislaufunterstützung. Med Klin Intensivmed Notfmed 114, 452–458 (2019). https://doi.org/10.1007/s00063-017-0336-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-017-0336-3

Schlüsselwörter

Keywords

Search

Navigation