Zusammenfassung
Wenn die konventionelle Therapie bei akuter oder chronischer Herzinsuffizienz nicht ausreicht, um eine adäquate Organperfusion zu gewährleisten, kann eine mechanische Unterstützung des linken Ventrikels die einzig lebensrettende Option sein. In den letzten Jahren sind zahlreiche, konzeptionell verschiedene perkutane mechanische Unterstützungssysteme entwickelt worden, die sich für die interventionelle Kardiologie und Intensivmedizin eignen. Das Indikationsspektrum perkutaner Unterstützungssysteme reicht vom primärprophylaktischen Einsatz bei komplexen Herzkatheterprozeduren über eine längerfristige Überbrückungstherapie bis hin zur Erholung, Transplantation oder dauerhaften mechanischen Unterstützung. Die Anwendung der intraaortalen Ballongegenpulsation kann im ischämischen kardiogenen Schock mangels Effektivität nicht mehr als Standardtherapie angesehen werden. Entsprechend werden für diese Indikation andere perkutane Systeme wie Mikroaxialpumpen sowie extrakorporale Membranoxygenierungs- bzw. Kreislaufunterstützungssysteme zur Linksherzunterstützung attraktiver, weil deren Wirkung auf die Hämodynamik überzeugender ist. Mit zunehmender Unterstützung steigt aber auch die Komplikationsrate aufgrund größerer Invasivität und Komplexität der Systeme. Die z. T. nicht unerheblichen Risiken sowie die Vorteile müssen aufgrund fehlender großer Studien individuell im Vergleich zur konventionellen Therapie mit hoch dosierten Inotropika abgewogen werden. In diesem Beitrag werden verschiedene Möglichkeiten und Besonderheiten der perkutanen Kreislaufunterstützung für das Herzkatheterlabor und die internistische Intensivstation zusammengefasst.
Abstract
In cases of low cardiac output and chronic cardiac failure despite conventional therapy, mechanical circulatory support may be the only option to ensure adequate organ perfusion and to save the life of the patient. In recent years, several conceptionally different methods of circulatory support have been developed for percutaneous application in interventional cardiology and intensive care. Indications range from elective use in complex cardiac interventions to long-term support as a bridge to recovery. As intra-aortic balloon pump support can no longer be considered for routine use in ischemic cardiogenic shock, micro-axial pumps for extracorporeal membrane oxygenation and extracorporeal life support systems (ECMO/ECLS) gain attractiveness due to a more convincing impact on the hemodynamics. However, an increasing level of support is paralleled by greater invasiveness and complexity of the systems. Due to a lack of larger comparative trials, the benefits and risks of adverse events must be balanced against those of conventional therapy with inotropes and largely on an individual basis. This review summarizes the options for percutaneous circulatory support with special consideration to applications in the catheter laboratory and intensive care units in internal medicine.
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Interessenkonflikt. T. Seidler gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Seidler, T. Perkutane mechanische Kreislaufunterstützung. Internist 55, 1267–1277 (2014). https://doi.org/10.1007/s00108-014-3505-y
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DOI: https://doi.org/10.1007/s00108-014-3505-y
Schlüsselwörter
- Kardiogener Schock
- Herzinsuffizienz
- Extrakorporale Kreislaufunterstützung
- Intraaortale Ballongegenpulsation
- Interventionelle Kardiologie