Die akute Herzinsuffizienz

Zusammenfassung

Mechanische Kreislaufunterstützung kann bei Patienten mit akuter Herzinsuffizienz zur hämodynamischen Stabilisierung eingesetzt werden, wenn andere Maßnahmen eine konsekutive Minderperfusion der Organe nicht beheben können. Neben der Behandlung der Grunderkrankung besitzen mechanische Kreislaufunterstützungssysteme somit einen Stellenwert in der Notfallversorgung und intensivmedizinischen Akutphase, um die relativ hohe Mortalität des unbehandelten kardiogenen Schock von bis zu 80 % auf die Hälfte zu reduzieren. Neue, minimal-invasive Systeme zur Kreislaufunterstützung können zukünftig hier das Indikationsspektrum erweitern.

Summary

Mechanical circulatory support can be used in patients suffering from acute heart failure if conventional measures are inadequate to provide hemodynamic stabilization to avoid organ hypoperfusion. In addition to treating the underlying disease such measures therefore play an important role in emergency and intensive care medicine, resulting in a reduction of the high mortality in untreated cardiogenic shock from up to 80 % to 40 %. Novel minimally-invasive circulatory support systems may extend the spectrum of indications in the future.

Schlüsselwörter

Herzinsuffizienz - Mechanische Kreislaufunterstützung - Multiorganversagen

Keywords

acute heart failure - mechanical ciculatory support - multiorgan failure

Literatur

• 1 Anderson R D, Ohman E M, Holmes jr D R. et al . Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I Study. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.  J Am Coll Cardiol. 1997;  30 708-715
• 2 Babaev A, Frederick P D, Pasta D J. et al . Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock.  JAMA. 2005;  294 448-454
• 3 Chen Y S, Lin J W, Yu H Y. et al . Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis.  Lancet. 2008;  372 554-561
• 4 Christenson J T, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients.  Eur J Cardiothorac Surg. 1997;  11 1097-1103
• 5 De Robertis F, Rogers P, Amrani M. et al . Bridge to decision using the Levitronix CentriMag short-term ventricular assist device.  J Heart Lung Transplant. 2008;  27 474-478
• 6 Eltchaninoff H, Simpfendorfer C, Franco I. et al . Early and 1-year survival rates in acute myocardial infarction complicated by cardiogenic shock: a retrospective study comparing coronary angioplasty with medical treatment.  Am Heart J. 1995;  130 459-464
• 7 Ferrari M, Aboulhosn W, Figulla H R. Successful high-risk coronary angioplasty in a patient with cardiogenic shock under circulatory assist with a 16F axial flow pump.  Catheter Cardiovasc Interv. 2005;  66 557-561
• 8 Ferrari M, Pfeifer R, Poerner T C, Figulla H R. Bridge to recovery in a patient with Churg-Strauss myocarditis by long-term percutaneous support with microaxial blood pump.  Heart. 2007;  93 (11) 1419
• 9 Frazier O H, Wampler R K, Duncan J M. et al . First human use of the Hemopump, a catheter-mounted ventricular assist device.  Ann Thorac Surg. 1990;  49 299-304
• 10 Hochman J S, Buller C E, Sleeper L A. et al . Cardiogenic shock complicating acute myocardial infarction – etiologies, management and outcome: a report from the SHOCK Trial Registry.   J Am Coll Cardiol. 2000;  36 1063-1070
• 11 Hochman J S, Sleeper L A, Webb J G. et al . Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock.  N Engl J Med. 1999;  341 625-634
• 12 Mebazaa A, Nieminen M S, Packer M. et al . Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial.  JAMA. 2007;  297 1883-1891
• 13 Mehlhorn U, Brieske M, Fischer U M. LIFEBRIDGE: a portable, modular, rapidly available „plug-and-play” mechanical circulatory support system.  Ann Thorac Surg. 2005;  80 1887-1892
• 14 Meyns B, Dens J, Sergeant P. et al . Initial experiences with the Impella device in patients with cardiogenic shock – Impella support for cardiogenic shock.  Thorac Cardiovasc Surg. 2003;  51 312-317
• 15 Ohman E M, Nanas J, Stomel R J. et al . Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial.  J Thromb Thrombolysis. 2005;  19 33-39
• 16 Sanborn T A, Sleeper L A, Bates E R. et al . Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry-- SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?.  J Am Coll Cardiol. 2000;  36 1123-1129
• 17 Sjauw K D, Engstrom A E, Vis M M. et al . A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?.  Eur Heart J. 2009;  30 459-468
• 18 Solomon S B, Minneci P C, Deans K J. et al . Effects of intra-aortic balloon counterpulsation in a model of septic shock.  Crit Care Med. 2009;  37 7-18
• 19 Steen S, Sjoberg T, Olsson P, Young M. Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompression resuscitation.  Resuscitation. 2005;  67 25-30
• 20 Thiele H, Sick P, Boudriot E. et al . Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock.  Eur Heart J. 2005;  26 1276-1283