Kardiale Assist-Systeme - Gegenwärtiger Stand

Abstract

The use of paracorporeal pneumatically accentuated blood pump systems is still indicated in cases of most severe biventricular heart failure and multiorgan failure or if only short- to mid-term circulatory support is anticipated. Well established indications for utilization of artificial blood pumps are the bridge-to-transplant procedure, which yields results comparable to primary heart transplantation, and acute cardiac failure following myocardial infarction or cardiac surgical procedures. In newborns and children, encouraging results were obtained when miniaturized blood pumps of the Berlin Heart System were utilized for heart failure in myocarditis or dilative cardiomyopathy. With advanced reliability of artificial blood pumps and in face of the high incidence of heart failure, especially in the older age group, the long-term application of artificial bloods pump appears to be justified.

Past, Present, and Future of Long‐Term Mechanical Cardiac Support in Adults

“…This demonstrates that the mortality rates significantly decline with increasing experience. The survival rates of these patients after cardiac transplantation are comparable to the patients one and five years after primary cardiac transplantation 5 …”

“…The pump chambers are placed on the abdominal wall of the patient and connected to the heart/great vessels by percutaneous conduits 4 . The Medos‐HIA and the Excor device provide pump chambers and conduits of different sizes that make their implantation not only in adults but also in neonates and children possible 4–7 . These patients are difficult to mobilize due to the external pump chambers, the risk of conduit kinking, and the large drive units 4 .…”

“…3), Jarvik 2000 LVAD (Jarvik Heart Inc., New York, NY, USA; Figs. 4 and 5), HeartMate II (Thoratec Corp.) and InCor (Berlin Heart AG) 5 …”

“…The inflow conduit is usually connected to the left ventricular (LV) apex and the outflow graft to the ascending or descending aorta 12 . A percutaneous driveline connects the pumps to an external controller and battery packs 5,10,12 . The internal pump housing of the DeBakey LVAD and its other components with blood contact have been coated with a Carmeda ® biocompatible coating to reduce the risk of thrombus formation, 10 but the results were disappointing, and therefore, it is no longer performed.…”

Review of Recent Results using Computational Fluid Dynamics Simulations in Patients Receiving Mechanical Assist Devices for End-Stage Heart Failure

“…11 The anastomosis site should be inspected for calcification, and the selection of cannula location should take into consideration the possibility of redo surgery for cardiac transplantation. 12 Furthermore, pulsatile flow showed more favorable hemodynamic conditions including reduced WSS and lower pressures in the ascending aorta when compared to continuousflow LVADs. Nonetheless, the number of nonpulsatile-flow devices has been increasing in clinical applications since those devices are usually smaller and produce less frequent bleeding and infections.…”