Mechanische myokardiale Unterstützungssysteme 1997Eine Übersicht von der intraaortalen Ballongegenpulsation bis zu den implantierbaren linksventrikulären Unterstützungssystemen

Abstract

The development of cardiopulmonary bypass (CPB) to support the systemic circulation during cardiac surgical procedures became a clinical reality in 1953. Although the use of CPB for the treatment of post-infarction cardiogenic shock met with little success, intra-aortic balloon counterpulsation was used successfully in 1968 to reduce ischaemic injury in a patient with cardiogenic shock. Today, a broad spectrum of circulatory assist devices for short- and long-term application is available. Three major indication groups for the use of support devices are established. In low-cardiac-output syndrome after cardiac surgical procedures, short-term devices are utilised to enable myocardial recovery. In transplantation candidates suffering from drug-resistant pump failure, the implantation of long-term devices as a bridge to heart transplantation is indicated, and in NYHA class IV patients with contraindications to heart transplantation, the implantation of long-term devices as an alternative to transplantation is under discussion. In the literature, post-cardiotomy support survival is less than 30% on average. About 70% of mechanically bridged patients have survived to undergo heart transplantation and were transplanted with over 90% survival. Major problems during mechanical support are infection, bleeding, and thromboembolism. In view of patients' natural course without support, these clinical results are favourable.

Therapie des akuten Herzversagens - Chirurgische Möglichkeiten

“…Diese unterteilen sich in externe Systeme mit Konnektierung der Pumpe an perkutan ausgeleitete Kanülen und interne Systeme, die abdominell implantierbar sind. Je nach System und Kanülierung ist mit diesen Devices sowohl eine isolierte univentrikuläre als auch eine biventrikuläre Kreislaufunterstützung möglich (14,15).…”