Linksventrikuläre Assist-Systeme – Verbesserungsmöglichkeiten in der ambulanten Versorgung

Abstract

The use of left-ventricular assist device therapy (LVAD) in terminal heart failure patients is increasing. Many patients are receiving LVAD-therapy as final solution (destination therapy). After discharge from the implanting heart center patient-centered care has to be implemented on an outpatient basis. A responsible ambulatory treatment of this severe heart failure population requires knowledge about LVAD specific problems (general medical care, long term complications, device management). The referring cardiologist as well as the private practitioner should be more involved in the care of patients with LVAD. By this means patients safety would increase and the overall costs decline not at least due to fewer hospital readmissions.

Immer mehr Patienten mit hochgradiger Linksherzinsuffizienz werden mit einem Assist-Device (LVAD) versorgt. Mit den Implantationszahlen steigen auch die Anforderungen an die ambulante medizinische Nachsorge: Entsprechend geschulte Hausärzte und niedergelassene Kardiologen könnten möglicherweise Komplikationen der Patienten mit LVAD vermeiden, deren Prognose verbessern und nicht zuletzt Kosten sparen helfen.

Schlüsselwörter

LVAD - Übersicht - terminale Herzinsuffizienz - ambulante Versorgung - Komplikationen

Key words

LVAD - Review - advanced heart failure - chronic outpatient management - complications

• Literatur

• 1 Todesursachenstatistik, Todesursachen in Deutschland. Wiesbaden: Statistisches Bundesamt; 2015
• 2 Pergantis P, Karbatsch T, Potapov E. et al. Therapieformen bei fortgeschrittener Herzinsuffizienz. Kardiologe 2016; 10: 119-130
• 3 Slaughter MS, Rogers JG, Milano CA. et al. Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device. N Engl J Med 2009; 361: 2241-2251
• 4 Rogers JG, Pagani FD, Tatooles AJ. et al. Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure. N Engl J Med 2017; 376 (05) 451-460
• 5 Patel SR, Jorde UP. Creating adequate pulsatility with a continuous flow left ventricular assist device: just do it!. Curr Opin Cardiol 2016; 31 (03) 329-336
• 6 Meineri M, Van Rensburg AE, Vegas A. Right ventricular failure after LVAD implantation: Prevention and treatment. Best Practice Res Clin Anaesthesiol 2012; 26: 217-229
• 7 Ponikowski P. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016; 37 (27) 2129-2200
• 8 Tschöpe C, Messroghli D, Schönrath F. et al. Therapie der chronischen Herzinsuffizienz. Dtsch Med Wochenschr 2015; 140 (06) 406-442
• 9 McMurray JJ, Packer M, Desai AS. et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med 2014; 371 (11) 993-1004
• 10 Rosenkranz SR, Gibbs SR, Wachter R. et al. Left ventricular heart failure and pulmonary hypertension. Eur Heart J 2016; 37 (12) 942-954
• 11 Brock AS, Cook JL, Rannen N. et al. A Not-So-Obscure Cause of Gastrointestinal Bleeding. N Engl J Med 2015; 372: 556-561
• 12 Willemsen D, Cordes C, Bjarnason-Wehrens E. et al. Rehabilitationsstandards für die Anschlussheilbehandlung und allgemeine Rehabilitation von Patienten mit einem Herzunterstützungssystem (VAD – ventricular assist device). Clin Res Cardiol Suppl 2016; 11: 2-49
• 13 Wilson SR, Givertz MM, Steward GC. et al. Ventricular assist devices. The challenges of outpatient management. J Am Coll Cardiol 2009; 54: 647-659
• 14 Estep DJ, Trachtenberg BH, Loza LP. et al. Continuous flow left ventricular assist devices: Shared care goals of monitoring and treating patients. debakey-journal 2015; 9 (01) 33-44
• 15 Smith EM, Franzwa J. Chronic outpatient management of patients with a left ventricular assist device. J Thor Disease 2015; 7 (12) 2112-2124
• 16 Bruce CR, Minard CG, Wilhelm LA. et al. Caregivers of Patients With Left Ventricular Assist Devices: Possible Impacts on Patients’ Mortality and Interagency Registry for Mechanically Assisted Circulatory Support-Defined Morbidity Events. Circ Cardiovasc Qual Outcomes 2017; 10: e002879
• 17 Wordingham SE, Swetz KM. Can anyone be prepared enough for life with an LVAD-DT?. The Am J Bioethics 2017; 17: 14-16
• 18 Langheim E, Reis N, Cordes C. et al. Cardiac Rehabilitation in Patients with Mechanical Circulatory Support. Dtsch Med Wochenschr 2017; 142 (04) 282-289
• 19 Hecker U, Tremmel A, Schmack B. Takt- und kraftlos – Wenn das Herz Unterstützung braucht. Retten 2015; 1: 50-59