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Chronische Herzinsuffizienz

Partielle Reversibilität durch linksventrikuläre mechanische Unterstützungssysteme

Congestive heart failure

Reverse cardiac remodeling mediated by left ventricular assist devices

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Zusammenfassung

Linksventrikuläre mechanische Unterstützungssysteme („left ventricular assist devices”; LVAD) werden bei terminaler Herzinsuffizienz entweder als „bridge to transplantation“ oder als „destination therapy“ bei Vorliegen von Kontraindikationen zur Herztransplantation eingesetzt. LVAD sind pulsatile oder nonpulsatile Systeme, die Blut vom linken Ventrikel parallel zur Zirkulation in die Aorta ascendens transportieren und so zu einer profunden Druck- und Volumenentlastung im linken Ventrikel führen. Bei einem Teil der Patienten kommt es infolge des Einsatzes des LVAD zu einer deutlichen Abnahme der Herzhypertrophie und -dilatation sowie zu einer signifikanten Verbesserung der kardialen Pumpfunktion. Dieser Prozess wird als „reverse cardiac remodeling” bezeichnet und ist durch Abnahme der Kardiomyozytengröße und reversible Regulation zahlreicher molekularer Systeme des Myokards gekennzeichnet.

Abstract

Left ventricular assist devices (LVAD) are currently used to treat patients with terminal congestive heart failure as a bridge to transplantation or as destination therapy in individuals with contraindications for cardiac transplantation. The LVADs are pulsatile or non-pulsatile systems that transport blood from the left ventricle to the ascending aorta parallel to the circulation thus providing a profound volume and pressure reduction in the left ventricle. The use of LVADs is associated with a considerable decrease of cardiac hypertrophy and dilation with significantly improved cardiac performance in a small subset of patients. The underlying process is termed reverse cardiac remodelling and is characterized by a significant decrease in the size of cardiomyocytes and reversible regulation of numerous molecular systems in the myocardium.

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Authors and Affiliations

  1. Institut für Pathologie und Neuropathologie, Universitätsklinik Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    J. Wohlschläger, T. Hager & H.A. Baba

  2. Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Deutschland

    H. Milting

  3. Klinik für Kardiologie und Angiologie, Universitätsklinik Münster, Münster, Deutschland

    J. Stypmann

  4. Klinik für Herz- und Thoraxchirurgie, Universitätsklinik Regensburg, Regensburg, Deutschland

    C. Schmid

  5. Institut für Pathologiephysiologie, Universitätsklinik Essen, Universität Duisburg-Essen, Essen, Deutschland

    B. Levkau

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  1. J. Wohlschläger
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  2. H. Milting
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  7. H.A. Baba
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Correspondence to J. Wohlschläger.

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Wohlschläger, J., Milting, H., Stypmann, J. et al. Chronische Herzinsuffizienz. Pathologe 33, 175–182 (2012). https://doi.org/10.1007/s00292-011-1559-3

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