Fortschritte bei implantierbaren mechanischen Kreislaufunterstüzungssystemen

Abstract

In recent years, ventricular assist devices (VAD) supporting the left (LVAD), the right (RVAD) or both ventricles (BVAD) have rapidly emerged as the standard of care for advanced heart failure patients. Both the numbers and ages of patients in which they are used are rising worldwide, especially when used as a permanent support (bridge to destination, BTD). Due to the continuing lack of donor organs, these devices now represent a viable alternative to bridge patients to transplantation (BTT), with a 1-year survival rate of 86%. BTD, especially in long-term support, might be a valid, and the sole, option for those patients in whom heart transplantation is contraindicated. Patient selection, pre- and intra-operative preparation, as well as the timing of VAD implantation are important factors critical to successful circulatory support. While BTT remains the goal in the majority of patients, the number of permanent VADs (i. e. BTD) is rising significantly. Although explantation of a VAD system as a bridge to recovery (BTR) can be considered in only a small number of patients, it represents a very special part of this therapy modality.

Driveline infections in left ventricular assist devices—Incidence, epidemiology, and staging proposal

“…In case of previous cardiac surgery without the need for additional intracardiac procedures other than thrombectomy from the left ventricle, we use a left lateral approach with anastomosis to the descending aorta. 13 If additional intracardiac procedures are necessary, redo median sternotomy is preferred. In patients on temporary mechanical circulatory support requiring no concomitant intracardiac procedures and who develop heparin-induced thrombocytopenia, the LVAD is usually implanted on temporary mechanical circulatory support to avoid complex anticoagulation for CPB.…”

A Not-Motorized Implantable Device for Partial Circulatory Support: A Proof of Concept Experiment

“…The number of left ventricle assistance devices implanted worldwide has increased dramatically and now exceeds the number of cardiac transplants. Many authors suggest nowadays that left ventricle assistance device implantation, not cardiac transplantation, is the main therapy for end-stage heart failure [1][2][3][4][5][6][7][8]. Despite advances in device technology, a sustained internal power source remains elusive.…”

“…Despite advances in device technology, a sustained internal power source remains elusive. A fully implantable circulatory assistance device without external connection and lifetime energy supply can eliminate a significant source of morbidity and mortality for patients (cable infections and redo) and improve the independence and quality of life of patients [4,5]. While the complex problems with energy sources are the subject of considerable research and investment, very few alternative options for improving cardiac output without energy source have also been taken into account and results were not so significant to be diffuse in clinical practice, such as: dynamic aortic-myoplasty or cardiac-myoplasty [9,10].…”