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Besonderheiten beim Einsatz von Kunstherzen

Special characteristics of the use of total artificial hearts

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

Zusammenfassung

Im Gegensatz zu anderen mechanischen Unterstützungssystemen werden komplette Kunstherzen („total artificial hearts“, TAH) orthotop implantiert. Typische Indikationen zur Verwendung eines TAH sind infarktbedingte Gewebezerstörungen nach Myokardinfarkten (z. B. ausgedehnter Vorderwandinfarkt und Infarktventrikelseptumdefekt) sowie die notfallmäßige Stabilisierung eines Patienten im kardiogenen Schock infolge eines biventrikulären Pumpversagens. Ziele der TAH-Therapie sind also die Stabilisierung des Patienten und die Überbrückung bis zur Transplantation. Eine primäre Langzeittherapie ist mit den aktuell verfügbaren Systemen nicht sinnvoll, da die erwartete Laufzeit sehr limitiert ist. Die Lebensqualität der Patienten am TAH ist im Vergleich mit aktuellen nichtpulsatilen linksventrikulären Unterstützungssystemen durch hohe Geräuschentwicklung und sperrige Antriebseinheiten oft deutlich eingeschränkt. Aufgrund der bauartbedingten Größe können Erwachsene mit kleinem Thoraxdurchmesser und Kinder in der Regel nicht mit einem TAH versorgt werden. Der vorliegende Beitrag beschreibt die Entwicklung der TAH und behandelt die Indikationen/Patientenselektion sowie Kontraindikationen der TAH-Implantation. Besonderes Augenmerk wird auf das perioperative Management und potenzielle Komplikationen gerichtet.

Abstract

In contrast to other mechanical assist systems, total artificial hearts (TAH) are implanted orthotopically. Typical indications for the implementation of a TAH are tissue destruction due to infarction after myocardial infarcts (e.g. extensive anterior wall infarct and ventricle septum infarct defects) and emergency stabilization of a patient in cardiogenic shock as a result of biventricular pump failure. The aim of TAH therapy is bridging and stabilization to transplantation. A primary long-term therapy with the currently available systems is not feasible because the expectation for running time is very limited. The patient quality of life with a TAH is often very limited in comparison to current non-pulsatile left ventricular assist devices due to unwieldy driver systems. Due to the construction-related size, adults with a small thoracic diameter and children cannot normally be treated with a TAH. This article describes the development of TAHs and deals in detail with the indications, patient selection and contraindications of TAH implantation. Special emphasis is given to the perioperative management and potential complications.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Morshuis, U. Schulz, E. Rehn und J. Gummert geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. HTX-Station, Herz- und Diabeteszentrum NRW, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland

    M. Morshuis, U. Schulz, E. Rehn & J. Gummert

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  1. M. Morshuis
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  2. U. Schulz
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  3. E. Rehn
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  4. J. Gummert
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Correspondence to U. Schulz.

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Der vorliegende Beitrag ist die aktualisierte Version eines Buchkapitels [59].

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Morshuis, M., Schulz, U., Rehn, E. et al. Besonderheiten beim Einsatz von Kunstherzen. Z Herz- Thorax- Gefäßchir 29, 38–46 (2015). https://doi.org/10.1007/s00398-014-1106-7

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  • DOI: https://doi.org/10.1007/s00398-014-1106-7

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