Mechanische Herz-Kreislauf-Unterstützung in der Kardiologie

Abstract

One out of 13 patients with an acute myocardial infarction is endangered of cardiogenic shock. In addition, acute valvular leakage, shunt vitiae, and acute myocarditis can lead to acute myocardial failure. As a therapeutic option, mechanical assist devices offer cardiac support and hemodynamic stabilization under these circumstances. The following minimal-invasive devices are used in cardiology and intensive care medicine: intra-aortic balloon pulsation (IABP), intra-vascular axial screw pumps, extra-corporal centrifugal pumps with and without additional membrane oxygenator. The IABP improves left ventricular function by a systolic reduction of the after-load, and an increase of diastolic blood pressure dependent on myocardial function. In contrast, axial screw pumps and centrifugal pumps can provide circulatory support independently of myocardial function. Mechanical assist devices can prevent irreversible damage not only by offering a reduction of myocardial work load, but also by improving organ perfusion in cardiogenic shock situations. Another indication for mechanical circulatory support depicts high-risk coronary angioplasty if the left ventricular ejection fraction is severely reduced or the target vessel supplies more than 50 % of vital myocardium. In case of irreversible heart failure, turbine pumps or centrifugal pumps offer a stabilization for the patient's transfer to a cardiac surgery center. They can also be used for bridging to heart transplantation in acute situations. Technical improvements will enhance the use of mechanical assist devices in the near future. Especially the development of portable emergency devices will enrich therapeutic possibilities in cardiology and intensive care medicine.

Superior venous drainage in the “LifeBox”: a portable extracorporeal oxygenator with a self-expanding venous cannula

“…Recently, a compact cardiopulmonary system (CPS) was designed for easy and rapid application 4,5 . These so-called mini-systems are equipped with a menuguided setup and a simple priming procedure particularly well-suited for emergency cardiopulmonary support where device readiness and safety are crucial.…”

Kardiogener Schock - Pharmakologische und mechanische Maßnahmen in der Akutphase

“…Die mechanische Kreislaufunterstützung im kardiogenen Schock stellt zur Aufrechterhaltung des Organperfusionsdruckes eine weitere Therapiemaßnahme dar [14]. Am häufigsten wird die intraaortale Ballonpumpe (IABP) eingesetzt, die durch eine entsprechende Inflation eines mit Helium gefüllten Ballons in der absteigenden Aorta während der Diastole im Mittel 40 ml Blut verdrängt, wodurch es zu einer Anhebung des diastolischen Blutdrucks und Verbesserung der Perfusion stenosierter Koronargefäße kommt.…”

Möglichkeiten und Grenzen der interventionellen Therapie bei akuter Herzinsuffizienz bei koronarer Herzerkrankung

“…Wenn in dieser Zeit keine Erholung der linksventrikulären Funktion erreicht werden kann, stehen operativ implantierbare intrathorakale VAD oder der künstliche Herzersatz (TAH ["total artificial heart"]) zur Verfügung, die auch den rechten Ventrikel unterstützen und somit ein längeres Zeitfenster bis zur Herztransplantation ermöglichen [9,39,51]. [11]. IABP: in traaortale Ballonpumpe; LVAD: mechanisches linksventrikuläres Unterstützungs system; pCPS: perkutan einsetzbares kardiopulmonales BypassSystem.…”

“…Flow chart for the acute management of cardiogenic shock[11]. IABP: in traaortic balloon pump; LVAD: left ventricular assist device; pCPS: percutaneous cardiopulmonary support.…”