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Mechanische Herz-Kreislauf-Unterstützung bei akutem Rechtsherzversagen

Mechanical cardiovascular support in acute right ventricular failure

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

Zusammenfassung

Das Versagen des rechten Ventrikels (RV) geht mit erheblicher Morbidität und Mortalität einher, wobei die Sterblichkeitsraten im Krankenhaus auf bis zu 70–75 % geschätzt werden. Rechtsherzversagen kann nach herzchirurgischen Operationen oder in bestimmten Situationen isoliert auftreten, wie z. B. nach einem akuten Myokardinfarkt, einer Lungenembolie oder Implantation eines Linksherzunterstützungssystems sowie nach einer Herztransplantation. Die medikamentöse Therapie umfasst die Optimierung des Volumenstatus sowie die Verabreichung von Inotropika, Vasopressoren und pulmonalen Vasodilatatoren. Ausgewählte Patienten mit anhaltendem RV-Versagen können von mechanischer Kreislaufunterstützung profitieren. Zunehmend werden perkutane und chirurgische, mechanische RV-Unterstützungssysteme eingesetzt. Systeme zur isolierten RV-Unterstützung umfassen perkutane Optionen wie Mikroaxialstrompumpen und extrakorporale Zentrifugalpumpe sowie chirurgische Optionen mit einem RV-Unterstützungssystem und venoarterieller extrakorporaler Membranoxygenierung. In dieser Übersicht werden Indikationen, Patientenauswahl, Behandlungsstrategien und Ergebnisse der mechanischen Kreislaufunterstützung bei RV-Versagen diskutiert.

Abstract

Right ventricular (RV) failure is associated with significant morbidity and mortality, with in-hospital mortality rates estimated to be as high as 70–75%. The RV failure can occur after cardiac surgery or isolated in certain situations, such as acute myocardial infarction, pulmonary embolism, left ventricular assist device implantation or after heart transplantation. Drug treatment includes fine tuning of the volume status and administration of inotropic agents, vasopressors and pulmonary vasodilators. Selected patients with persistent RV failure may benefit from mechanical circulatory support. Percutaneous and surgical mechanical support systems are increasingly being used. Systems for isolated RV support include percutaneous options, such as micro-axial flow pumps and extracorporeal centrifugal flow support devices as well as surgical options with RV support devices and arteriovenous extracorporeal membrane oxygenation. This review discusses the indications, patient selection, treatment strategies and outcomes of mechanical circulatory support for RV failure.

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Literatur

  1. Abiomed (2020) FDA Issues Emergency Use Authorization for Impella RP as Therapy for COVID-19 Patients With Right Heart Failure. In: Today E (Hrsg) (In)

  2. Administration USFaD (2019) UPDATE: Increased Rate of Mortality in Patients Receiving Abiomed Impella RP System—Letter to Health Care Providers

    Google Scholar 

  3. Aggarwal V, Einhorn BN, Cohen HA (2016) Current status of percutaneous right ventricular assist devices: First-in-man use of a novel dual lumen cannula. Catheter Cardiovasc Interv 88:390–396

    Article  PubMed  Google Scholar 

  4. Aghili N, Bader Y, Vest AR et al (2016) Biventricular Circulatory Support Using 2 Axial Flow Catheters for Cardiogenic Shock Without the Need for Surgical Vascular Access. Circ Cardiovasc Interv 9:

  5. Anderson MB, Goldstein J, Milano C et al (2015) Benefits of a novel percutaneous ventricular assist device for right heart failure: The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant 34:1549–1560

    Article  PubMed  Google Scholar 

  6. Chopski SG, Murad NM, Fox CS et al (2019) Mechanical Circulatory Support of the Right Ventricle for Adult and Pediatric Patients With Heart Failure. ASAIO J 65:106–116

    Article  PubMed  Google Scholar 

  7. Coromilas EJ, Takeda K, Ando M et al (2019) Comparison of Percutaneous and Surgical Right Ventricular Assist Device Support After Durable Left Ventricular Assist Device Insertion. J Card Fail 25:105–113

    Article  PubMed  Google Scholar 

  8. De Robertis F, Birks EJ, Rogers P et al (2006) Clinical performance with the Levitronix Centrimag short-term ventricular assist device. J Heart Lung Transplant 25:181–186

    Article  PubMed  Google Scholar 

  9. DeFilippis EM, Topkara VK, Kirtane AJ et al (2022) Mechanical Circulatory Support for Right Ventricular Failure. Card Fail Rev 8:e14

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dell’italia LJ, Lembo NJ, Starling MR et al (1987) Hemodynamically important right ventricular infarction: follow-up evaluation of right ventricular systolic function at rest and during exercise with radionuclide ventriculography and respiratory gas exchange. Circulation 75:996–1003

    Article  PubMed  Google Scholar 

  11. Doll JA, Ohman EM, Patel MR et al (2016) A team-based approach to patients in cardiogenic shock. Cathet Cardio Intervent 88:424–433

    Article  Google Scholar 

  12. Elder M, Blank N, Kaki A et al (2018) Mechanical circulatory support for acute right ventricular failure in the setting of pulmonary embolism. J Interv Cardiol 31:518–524

    Article  PubMed  Google Scholar 

  13. Ferrari MW, Schulze PC, Kretzschmar D (2020) Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device. Ther Adv Cardiovasc Dis 14:1753944719895902

    Article  PubMed  PubMed Central  Google Scholar 

  14. Guglin M, Zucker MJ, Bazan VM et al (2019) Venoarterial ECMO for Adults: JACC Scientific Expert Panel. J Am Coll Cardiol 73:698–716

    Article  PubMed  Google Scholar 

  15. Haneya A, Philipp A, Puehler T et al (2012) Temporary percutaneous right ventricular support using a centrifugal pump in patients with postoperative acute refractory right ventricular failure after left ventricular assist device implantation. Eur J Cardiothorac Surg 41:219–223

    PubMed  Google Scholar 

  16. Kalogeropoulos AP, Kelkar A, Weinberger JF et al (2015) Validation of clinical scores for right ventricular failure prediction after implantation of continuous-flow left ventricular assist devices. J Heart Lung Transplant 34:1595–1603

    Article  PubMed  Google Scholar 

  17. Kapur NK, Esposito ML, Bader Y et al (2017) Mechanical Circulatory Support Devices for Acute Right Ventricular Failure. Circulation 136:314–326

    Article  PubMed  Google Scholar 

  18. Kapur NK, Jumean M, Ghuloom A et al (2015) First Successful Use of 2 Axial Flow Catheters for Percutaneous Biventricular Circulatory Support as a Bridge to a Durable Left Ventricular Assist Device. Circ Heart Fail 8:1006–1008

    Article  PubMed  Google Scholar 

  19. Kapur NK, Paruchuri V, Jagannathan A et al (2013) Mechanical circulatory support for right ventricular failure. JACC Heart Fail 1:127–134

    Article  PubMed  Google Scholar 

  20. Konstam MA, Kiernan MS, Bernstein D et al (2018) Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation 137:e578–e622

    Article  PubMed  Google Scholar 

  21. Kretzschmar D, Schulze PC, Ferrari MW (2019) Concept, Evaluation, and Future Perspectives of PERKAT(R) RV‑A Novel Right Ventricular Assist Device. J Cardiovasc Transl Res 12:150–154

    Article  PubMed  Google Scholar 

  22. Krishnamoorthy A, Devore AD, Sun JL et al (2017) The impact of a failing right heart in patients supported by intra-aortic balloon counterpulsation. Eur Heart J Acute Cardiovasc Care 6:709–718

    Article  PubMed  Google Scholar 

  23. Kuchibhotla S, Esposito ML, Breton C et al (2017) Acute Biventricular Mechanical Circulatory Support for Cardiogenic Shock. J Am Heart Assoc 6:

  24. Lavee J, Mulzer J, Krabatsch T et al (2018) An international multicenter experience of biventricular support with HeartMate 3 ventricular assist systems. J Heart Lung Transplant 37:1399–1402

    Article  PubMed  Google Scholar 

  25. Mcgiffin D, Kure C, Mclean J et al (2021) The results of a single-center experience with HeartMate 3 in a biventricular configuration. J Heart Lung Transplant 40:193–200

    Article  PubMed  Google Scholar 

  26. Nagy CD, Jumean MF, Pham DT et al (2013) Percutaneous circulatory support for biventricular failure. Circ Cardiovasc Interv 6:e12–14

    Article  PubMed  Google Scholar 

  27. Ntalianis A, Kapelios CJ, Kanakakis J et al (2015) Prolonged intra-aortic balloon pump support in biventricular heart failure induces right ventricular reverse remodeling. Int J Cardiol 192:3–8

    Article  PubMed  Google Scholar 

  28. Oßwald A, Ruhparwar A, Schmack B (2020) TandemHeart: perkutanes rechtsventrikuläres Assist Device. In: Boeken U, Assmann A, Klotz S, Born F, Rieth A, Schmid C (Hrsg) Mechanische Unterstützung im akuten Kreislaufversagen. Springer Berlin Heidelberg, Berlin, Heidelberg, S 95–109

    Chapter  Google Scholar 

  29. Pappalardo F, Scandroglio AM, Latib A (2018) Full percutaneous biventricular support with two Impella pumps: the Bi-Pella approach. ESC Heart Fail 5:368–371

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pieri M, Pappalardo F (2018) Impella RP in the Treatment of Right Ventricular Failure: What We Know and Where We Go. J Cardiothorac Vasc Anesth 32:2339–2343

    Article  PubMed  Google Scholar 

  31. Rao P, Khalpey Z, Smith R et al (2018) Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest. Circ Heart Fail 11:e4905

    Article  PubMed  Google Scholar 

  32. Ravichandran AK, Baran DA, Stelling K et al (2018) Outcomes with the Tandem Protek Duo Dual-Lumen Percutaneous Right Ventricular Assist Device. ASAIO J 64:570–572

    Article  PubMed  Google Scholar 

  33. Schmack B, Weymann A, Popov AF et al (2016) Concurrent Left Ventricular Assist Device (LVAD) Implantation and Percutaneous Temporary RVAD Support via CardiacAssist Protek-Duo TandemHeart to Preempt Right Heart Failure. Med Sci Monit Basic Res 22:53–57

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schrage B, Burkhoff D, Rübsamen N et al (2018) Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock. JACC Heart Fail 6:1035–1043

    Article  PubMed  Google Scholar 

  35. Sultan I, Kilic A, Kilic A (2018) Short-Term Circulatory and Right Ventricle Support in Cardiogenic Shock Extracorporeal Membrane Oxygenation, Tandem Heart, CentriMag, and Impella. Heart Fail Clin 14:579 (+)

    Article  PubMed  Google Scholar 

  36. Sy E, Sklar MC, Lequier L et al (2017) Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care 39:87–96

    Article  PubMed  Google Scholar 

  37. Takayama H, Landes E, Truby L et al (2015) Feasibility of smaller arterial cannulas in venoarterial extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 149:1428–1433

    Article  PubMed  Google Scholar 

  38. Tran HA, Pollema TL, Enciso JS et al (2018) Durable Biventricular Support Using Right Atrial Placement of the HeartWare HVAD. Asaio J 64:323–327

    Article  PubMed  Google Scholar 

  39. Tschöpe C, Van Linthout S, Klein O et al (2019) Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts. J Cardiovasc Transl Res 12:116–123

    Article  PubMed  Google Scholar 

  40. Yoshioka D, Takayama H, Garan RA et al (2017) Contemporary outcome of unplanned right ventricular assist device for severe right heart failure after continuous-flow left ventricular assist device insertion. Interact Cardiovasc Thorac Surg 24:828–834

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Herzchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Krankenhausstr. 12, 91054, Erlangen, Deutschland

    Saya Aziz, Oliver Dewald, René Tandler & Christian Heim

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  1. Saya Aziz
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  2. Oliver Dewald
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  3. René Tandler
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  4. Christian Heim
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Correspondence to Saya Aziz.

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S. Aziz, O. Dewald, R. Tandler und C. Heim 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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Aziz, S., Dewald, O., Tandler, R. et al. Mechanische Herz-Kreislauf-Unterstützung bei akutem Rechtsherzversagen. Z Herz- Thorax- Gefäßchir (2024). https://doi.org/10.1007/s00398-024-00641-6

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