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Kardiopulmonaler Bypass in der Herzchirurgie

Cardiopulmonary bypass in cardiac surgery

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Zusammenfassung

Der kardiopulmonale Bypass („cardiopulmonary bypass“, CPB) ist ein Standardverfahren der Herzchirurgie. Neben den therapeutischen Perspektiven, die dieses Verfahren eröffnet, ist es selbst Ausgangspunkt für systemische und organspezifische Komplikationen. Typische Organkomplikationen sind Herzinsuffizienz, renale und pulmonale Dysfunktionen, Gerinnungsalterationen sowie neurologische und kognitive Einschränkungen. Die immunologische Reaktion auf die extrakorporale Zirkulation (EKZ) löst eine systemische Inflammation aus, die häufig die Definitionskriterien eines „systemic inflammatory response syndrome“ (SIRS) erfüllt. Die wesentlichen Ursachen hierfür sind der Kontakt des Bluts zur künstlichen Oberfläche der Herz-Lungen-Maschine (HLM), der mechanische Stress, der auf die Blutbestandteile einwirkt, und das beträchtliche operative Trauma. Eine Vielzahl an technischen Veränderungen der HLM zielt auf eine Reduktion der Inflammationsreaktion durch den CPB ab. Aus operationstechnischen Gründen kann heute bei einem Großteil des kardiochirurgischen Operationsspektrums noch nicht auf eine EKZ verzichtet werden. Es werden jedoch kontinuierlich Verfahren entwickelt, die das Ziel verfolgen, das operative Trauma und die negativen Auswirkungen des CPB zu reduzieren. Als positiv haben sich diesbezüglich verkleinerte Systeme mit biokompatiblen Oberflächen erwiesen. Alternative Verfahren wie die koronarchirurgische „Off-pump“-Chirurgie reduzieren CPB-assoziierte Organkomplikationen, werden jedoch aufgrund systemspezifischer Limitationen die konventionelle Bypasschirurgie nicht ersetzen können.

Abstract

Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.

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Danksagung

Die Autoren danken Frau Angela Frintrup, Herrn Priv.-Doz. Dr. Jörg Linneweber (Klinik für Kardiovaskuläre Chirurgie, Charité-Universitätsmedizin Berlin) und Harald Keller (Universitätskliniken Frankfurt a. M.) für die konstruktive Kritik bei der Erstellung des Beitrags.

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  1. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland

    T. Baehner, O. Boehm, A. Hoeft, G. Baumgarten &  P. Knuefermann

  2. Klinik und Poliklinik für Herzchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland

    C. Probst

  3. Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Deutschland

    B. Poetzsch

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  1. T. Baehner
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  2. O. Boehm
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  3. C. Probst
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  4. B. Poetzsch
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  5. A. Hoeft
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  6. G. Baumgarten
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  7. P. Knuefermann
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Correspondence to P. Knuefermann.

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Baehner, T., Boehm, O., Probst, C. et al. Kardiopulmonaler Bypass in der Herzchirurgie. Anaesthesist 61, 846–856 (2012). https://doi.org/10.1007/s00101-012-2050-0

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  • DOI: https://doi.org/10.1007/s00101-012-2050-0

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