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Mechanische Herz-Kreislauf-Unterstützung mittels intraaortaler Ballongegenpulsation

Grundlagen und eigene Ergebnisse

Mechanical cardiovascular support using intraaortic balloon counterpulsation

Fundamentals and our own results

  • Kardiotechnik/EKZ
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

In der kardiovaskulären Medizin und insbesondere im Rahmen der invasiven Behandlung der koronaren Herzkrankheit stellt die intraaortale Ballongegenpulsation (IABP) ein vielfach bewährtes Verfahren dar, welches auch heute im Zeitalter der mechanischen Herz-Kreislauf-Unterstützung noch immer eine wichtige Rolle im klinischen Alltag spielt. Sie kommt hierbei sowohl periinterventionell im Herzkatheterlabor als auch perioperativ im Rahmen einer chirurgischen Revaskularisation zunehmend zum Einsatz. Die Ballonpumpe unterstützt invasiv die Hämodynamik des Patienten durch eine Steigerung von diastolischer Perfusion und diastolischem Blutdruck. Diese Mechanismen bewirken eine Verbesserung der Koronarperfusion während der Diastole und eine Reduzierung der Nachlast des Herzens. Die Wirksamkeit der IABP konnte in einer Vielzahl klinischer Situationen bewiesen werden. Als klassische Indikationen gelten: akutes Koronarsyndrom, sog. High-risk-Koronarinterventionen im Rahmen einer Herzkatheteruntersuchung, kardiogener Schock und der gesamte perioperative Bereich innerhalb der Herzchirurgie. Die möglichen Komplikationen der intraaortalen Gegenpulsation können durchaus schwerwiegend sein, obwohl sie in ihrer Inzidenz deutlich abgenommen haben. Bei sorgfältiger Patientenselektion und Implantationstechnik stellt die IABP eine effektive Therapieoption in der Behandlung von Patienten mit kardiovaskulären Erkrankungen dar. Die folgende Arbeit fasst die hämodynamischen Veränderungen, Indikationen, Komplikationen und Ergebnisse bei der Verwendung der IABP zusammen.

Abstract

In cardiovascular medicine and coronary intervention, the intraaortic balloon pump (IABP) is a proven technology that plays an important role in circulatory support. The balloon pump invasively supports patient hemodynamics by augmenting diastolic perfusion and increasing diastolic blood pressure, thereby increasing coronary perfusion and reducing afterload. Its efficacy has been demonstrated in a multitude of clinical situations, including acute coronary syndromes, high-risk coronary interventions, cardiogenic shock, and cardiovascular surgery. The potential complications of aortic counterpulsation are serious, although much lower than in former times. With proper patient selection, insertion technique, and management, the IABP is a powerful device to assist in the treatment of patients with cardiovascular disease. Hemodynamics, indications, complications, and results associated with IABP use are reviewed.

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Authors and Affiliations

  1. Klinik für Kardiovaskuläre Chirurgie, Heinrich Heine Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    U. Boeken, P. Feindt, P. Schurr & A. Lichtenberg

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  1. U. Boeken
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  2. P. Feindt
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  3. P. Schurr
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  4. A. Lichtenberg
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Correspondence to U. Boeken.

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Boeken, U., Feindt, P., Schurr, P. et al. Mechanische Herz-Kreislauf-Unterstützung mittels intraaortaler Ballongegenpulsation. Z Herz- Thorax- Gefäßchir 24, 58–65 (2010). https://doi.org/10.1007/s00398-009-0754-5

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  • DOI: https://doi.org/10.1007/s00398-009-0754-5

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