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„Rise of the machines?“

Linksventrikuläre Unterstützungssysteme zur Behandlung der schweren Herzinsuffizienz

Rise of the machines?

Left ventricular assist devices for treatment of severe heart failure

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Zusammenfassung

Der Einsatz von linksventrikulären Unterstützungssystemen („left ventricular assist device“, LVAD) zur Behandlung der schweren Herzinsuffizienz hat in den vergangenen Jahren an Bedeutung gewonnen. Angesichts eines chronischen Mangels an Spenderorganen übersteigt die Anzahl der weltweiten LVAD-Implantationen bereits heute die der Herztransplantationen um ein Vielfaches. Mithilfe von Pumpensystemen neuerer Generation mit nichtpulsatilem Fluss konnten das Überleben, die Lebensqualität sowie die Beschwerdesymptomatik der Patienten im Vergleich zur optimierten medikamentösen Therapie verbessert werden. Neben der Überbrückung zur Herztransplantation („bridge to transplant“) hat sich die Dauertherapie („destination therapy“) als Implantationsstrategie etabliert. Eine sorgfältige Patientenselektion ist für ein gutes Ergebnis nach LVAD-Implantation essenziell; große Bedeutung hat dabei auch die Risikoabschätzung eines postoperativen Rechtsherzversagens. Die Hospitalisierungsrate unter LVAD-Therapie ist weiterhin hoch, trotz der schrittweisen Ausweitung der Therapie auf weniger kranke Herzinsuffizienzpatienten. Ein effektives peri- und postoperatives Management kann dazu beitragen, die Komplikationsrate (insbesondere Blutungen, Infektionen, thrombembolische Ereignisse und Rechtsherzversagen) zu senken und die ermutigenden Ergebnisse der mechanischen Kreislaufunterstützung weiter zu verbessen.

Abstract

The use of left ventricular assist devices (LVAD) as a treatment for severe heart failure has gained momentum in recent years. Even at this stage the number of worldwide LVAD implantations far exceeds the volume of heart transplantations in view of the chronic shortage of donor organs. Third generation continuous flow assist devices have helped to improve survival, quality of life and symptom burden of heart failure patients in comparison to a regimen of optimal medication management. Alongside bridging to transplantation, destination therapy has become an established strategy of LVAD implantation. A careful patient selection process is crucial for a good clinical outcome after device implantation and risk assessment for postoperative right ventricular failure is of particular importance in this context. The rate of hospitalization during LVAD support is still high, despite the step-wise attempts to widen the indications to less severely ill heart failure patients. An effective perioperative and postoperative management will help to lower the incidence of complications (e.g. bleeding, infections, thromboembolic events and right ventricular failure) and to improve the encouraging results of mechanical circulatory support.

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Authors and Affiliations

  1. Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland

    A. Ujeyl & M. Krüger

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  1. A. Ujeyl
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  2. M. Krüger
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A. Ujeyl und M. Krüger geben an, dass kein Interessenkonflikt besteht.

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Ujeyl, A., Krüger, M. „Rise of the machines?“. Herz 40, 972–979 (2015). https://doi.org/10.1007/s00059-015-4365-5

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