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Entlastung des linken Ventrikels während kurzfristiger Kreislaufunterstützung

Relief of the left ventricle during short-term circulatory support

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

Zusammenfassung

Unter mechanischer Kreislaufunterstützung, im Sinne einer venoarteriellen ECLS, ist die fehlende Entlastung des linken Ventrikels ein wesentliches und schwer vorhersehbares klinisches Problem. Die Integration eines zusätzlichen, chirurgisch eingebrachten „Venting“-Katheters in den venösen Schenkel des ECLS-Systems stellt einen deutlichen Eingriff in das System mit potenziellen Risiken, wie z. B. Luftembolien, dar. Der Einsatz von weiteren mechanischen Kreislaufunterstützungssystemen, wie der intraaortalen Ballonpumpe (IABP) oder einer transvasalen Mikroaxialpumpe (Impella®, Abiomed, Denvers, MA, USA), ist bisher nicht in prospektiven Studien oder Registern untersucht. Die retrospektiven Daten und Metaanalysen bezüglich der IABP zeigen widersprüchliche Evidenz. Der Einsatz der Impella® zusätzlich zur ECLS (sog. ECMELLA- oder ECPELLA-Konzept) scheint die Rate an entwöhnbaren Patienten von mechanischer Kreislaufunterstützung zu steigern und die Krankenhaussterblichkeit zu verringern. Bezüglich einer generellen Empfehlung dieser Therapie fehlen prospektive Daten mit einer klaren Definition der fehlenden linksventrikulären Entlastung anhand klinischer Parameter oder Untersuchungsbefunde.

Abstract

Insufficient unloading of the left ventricle during mechanical circulatory support by venoarterial ECLS constitutes a major clinical problem, which is difficult to predict. The integration of a surgical venting catheter within the venous part of the ECLS system represents a major intervention in the system with potential risks, such as air embolism. The use of additional mechanical circulatory support systems, like an intra-aortic balloon pump (IABP) or a transvascular micropump (Impella®) has currently not been investigated in prospective studies or registries. The retrospective data and meta-analysis on the use of IABP concomitant to ECLS show conflicting data. The use of the Impella® concomitant to the ECLS (ECMELLA or ECPELLA concept) seems to increase the rate of patients being able to be weaned off mechanical circulatory support as well as to decrease the in-hospital mortality rate. Regarding a clear recommendation of this concept, prospective data are still missing as well as a clear definition of insufficient unloading based on clinical parameters or investigations.

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Literatur

  1. Alkhouli M, Narins CR, Lehoux J et al (2016) Percutaneous decompression of the left ventricle in cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation. J Card Surg 31:177–182. https://doi.org/10.1111/jocs.12696

    Article  PubMed  Google Scholar 

  2. Aso S, Matsui H, Fushimi K, Yasunaga H (2016) In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Crit Care 20:80. https://doi.org/10.1186/s13054-016-1261-1

    Article  PubMed  PubMed Central  Google Scholar 

  3. Barbone A, Malvindi PG, Ferrara P, Tarelli G (2011) Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg 13:293–295. https://doi.org/10.1510/icvts.2011.269795

    Article  PubMed  Google Scholar 

  4. Bréchot N, Demondion P, Santi F et al (2017) Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care 58:2048872617711169. https://doi.org/10.1177/2048872617711169

    Article  Google Scholar 

  5. Cheng R, Hachamovitch R, Makkar R et al (2015) Lack of survival benefit found with use of Intraaortic balloon pump in extracorporeal membrane oxygenation: a pooled experience of 1517 patients. J Invasive Cardiol 27:453–458

    PubMed  Google Scholar 

  6. Fiore A, Gueldich M, Derbel H, Piscitelli M (2020) Aortic thrombosis due to a competitive blood flow with double mechanical circulatory assistance. Eur J Cardiothorac Surg. https://doi.org/10.1093/ejcts/ezaa015

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lim HS (2017) The effect of impella CP on cardiopulmonary physiology during venoarterial extracorporeal membrane oxygenation support. Artif Organs 29:135. https://doi.org/10.1111/aor.12923

    Article  CAS  Google Scholar 

  8. Lorusso R (2017) Are two crutches better than one? The ongoing dilemma on the effects and need for left ventricular unloading during veno-arterial extracorporeal membrane oxygenation. Eur J Heart Fail 19:413–415. https://doi.org/10.1002/ejhf.695

    Article  PubMed  Google Scholar 

  9. Lorusso R, Raffa GM, Heuts S et al (2020) Pulmonary artery cannulation to enhance extracorporeal membrane oxygenation management in acute cardiac failure. Interact Cardiovasc Thorac Surg 30:215–222. https://doi.org/10.1093/icvts/ivz245

    Article  PubMed  Google Scholar 

  10. Pappalardo F, Schulte C, Pieri M et al (2017) Concomitant implantation of Impella(®) on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail 19:404–412. https://doi.org/10.1002/ejhf.668

    Article  PubMed  Google Scholar 

  11. Patel SM, Lipinski J, Al-Kindi SG et al (2018) Simultaneous Venoarterial extracorporeal membrane oxygenation and percutaneous left ventricular decompression therapy with impella is associated with improved outcomes in refractory cardiogenic shock. ASAIO J. https://doi.org/10.1097/mat.0000000000000767

    Article  PubMed  PubMed Central  Google Scholar 

  12. Radakovic D, Zittermann A, Knezevic A et al (2021) Left ventricular unloading during extracorporeal life support for myocardial infarction with cardiogenic shock: surgical venting versus Impella device. Interact Cardiovasc Thorac Surg 34:ivab230. https://doi.org/10.1093/icvts/ivab230

    Article  Google Scholar 

  13. Schrage B, Becher PM, Bernhardt A et al (2020) Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation. Circulation 142:2095–2106. https://doi.org/10.1161/circulationaha.120.048792

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Seib PM, Faulkner SC, Erickson CC et al (1999) Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation. Catheter Cardiovasc Interv 46:179–186. https://doi.org/10.1002/(sici)1522-726x(199902)46:2〈179::aid-ccd13〉3.3.co;2‑n

    Article  CAS  PubMed  Google Scholar 

  15. Tepper S, Masood MF, Garcia MB et al (2017) Left ventricular unloading by Impella device versus surgical vent during extracorporeal life support. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2016.12.049

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg • Bad Krozingen, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    David Schibilsky, Friedhelm Beyersdorf, Matthias Siepe & Christoph Benk

  2. Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland

    David Schibilsky, Friedhelm Beyersdorf, Matthias Siepe & Christoph Benk

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  1. David Schibilsky
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  2. Friedhelm Beyersdorf
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Correspondence to David Schibilsky.

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Interessenkonflikt

D. Schibilsky ist als Consultant für die Firma Abiomed tätig. F. Beyersdorf, M. Siepe und C. Benk geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schibilsky, D., Beyersdorf, F., Siepe, M. et al. Entlastung des linken Ventrikels während kurzfristiger Kreislaufunterstützung. Z Herz- Thorax- Gefäßchir 36, 385–388 (2022). https://doi.org/10.1007/s00398-022-00526-6

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  • DOI: https://doi.org/10.1007/s00398-022-00526-6

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