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Temporäre mechanische Kreislaufunterstützung bei Kindern und Patienten mit angeborenen Herzfehlern

Temporary mechanical circulatory support in children and patients with congenital heart disease

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

Zusammenfassung

Ventrikuläre Assistenzsysteme („ventricular assist device“, VAD) werden bei Kindern mit terminaler Herzinsuffizienz als Überbrückungstherapie zur Herztransplantation oder zur myokardialen Erholung seit über 20 Jahren eingesetzt. Bei Kindern unter 20 kgKG werden parakorporale Pumpen (Excor® Pediatric) in einer uni- oder biventrikulären Konfiguration implantiert. Für größere Kindern stehen implantierbare Pumpen, z. B. HeartWare HVAD®, zur Verfügung. Indikationen im Kindesalter sind Kardiomyopathie oder Myokarditis und angeborene Herzfehler (AHF). Die Wartezeiten bis zur Transplantation haben sich erheblich verlängert; Unterstützungszeiten von mehr als einem Jahr sind auch im Kindesalter keine Seltenheit mehr. Die Überlebensraten konnten durch zunehmende Erfahrung und technische Verbesserungen deutlich erhöht werden und betragen bei normalen anatomischen Verhältnissen etwa 80 %. Die Herzunterstützung von Kindern mit AHF geht mit einer schlechteren Prognose einher (Überlebensraten von etwa 50 %). Hauptkomplikationen während der Herzunterstützung sind thrombembolische Ereignisse, die in etwa 25 % der Fälle auftreten. Aktuelle Entwicklungstendenzen sind die Miniaturisierung der VAD, um die Lebensqualität der Kinder zu erhöhen, sowie technische Modifikationen, um das Risiko von thrombembolischen Ereignissen zu vermindern.

Abstract

Ventricular assist devices (VAD) in children with terminal heart failure have been used as a bridge to transplantation or myocardial recovery for more than 20 years. The Berlin Heart Excor® Pediatric VAD is approved for use either as univentricular or biventricular support for children with a body weight less than 20 kg. Larger children can be supported with implantable continuous flow devices, e.g. HeartWare HVAD. Indications for support are cardiomyopathy, myocarditis and terminal heart failure in patients with congenital heart diseases. Due to the shortage of donors support time on VADs has greatly increased often lasting longer than 1 year. Although increased experience and technical modifications over the last decade have substantially improved the outcome of patients on VAD support, much is still dependent on the etiology of the heart failure. The survival rate in children with normal anatomy is approximately 80 % compared to 50 % in children with congenital heart diseases. The main complications during VAD support which occur in nearly 25 % of children weighing less than 20 kg are thromboembolic events. Miniaturization of the device to improve the quality of life for children on support and minimizing the risk of thromboembolic events are current fields of intensive research.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. O. Miera, E.V. Potapov, V. Alexi-Meskishvili, M. Hübler, Y. Weng und R. Hetzer geben an, dass kein Interessenkonflikt besteht. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Angeborene Herzfehler/ Kinderkardiologie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    O. Miera

  2. Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Deutschland

    E.V. Potapov, V. Alexi-Meskishvili, Y. Weng & R. Hetzer

  3. Klinik für Herz- und Gefäßchirurgie, Universitätsspital Zürich, Zürich, Schweiz

    M. Hübler

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  1. O. Miera
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  2. E.V. Potapov
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  3. V. Alexi-Meskishvili
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  4. M. Hübler
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  5. Y. Weng
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  6. R. Hetzer
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Correspondence to O. Miera.

Additional information

Der vorliegende Beitrag ist eine aktualisierte Version des Buchkapitels: Potapov EV, Hübler M, Miera O et al (2013) Dauerhafte mechanische Kreislaufunterstützung bei Kindern und Patienten mit angeborenen Herzfehlern. In: Boeken U, Assmann A, Born F, Schmid C (Hrsg) Mechanische Herz-Kreislauf-Unterstützung. Indikationen, Systeme, Implantationstechniken. Springer, Berlin Heidelberg New York Tokio, S 199–210 [31].

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Miera, O., Potapov, E., Alexi-Meskishvili, V. et al. Temporäre mechanische Kreislaufunterstützung bei Kindern und Patienten mit angeborenen Herzfehlern. Z Herz- Thorax- Gefäßchir 28, 277–282 (2014). https://doi.org/10.1007/s00398-014-1076-9

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  • DOI: https://doi.org/10.1007/s00398-014-1076-9

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