Terminale Herzinsuffizienz

Zusammenfassung

Terminale Herzinsuffizienz ist definiert als ein nach Leitlinien austherapierter Zustand mit der Notwendigkeit einer pharmakologischen und/oder mechanischen Kreislaufunterstützung. Wichtig ist eine genaue Einteilung der Patienten, wie mit dem INTERMACS-Score, um die weiteren diagnostischen und therapeutischen Maßnahmen abzuleiten. Neben dem Einsatz von positiv inotropen Substanzen und Vasopressoren kommen Ultrafiltration, perkutane und chirurgische kardiale Assist-Systeme sowie die Herztransplantation zum Einsatz. Integrierte Versorgungsstrukturen an spezialisierten Zentren, wie beispielsweise eine Herzinsuffizienz-Wachstation, werden zunehmend gebraucht, um der wachsenden Prävalenz und der Komplexität der terminalen Herzinsuffizienz und dem rasanten technischen Fortschritt gerecht zu werden.

Abstract

Terminal heart failure is end-stage heart failure with need for inotropic and/or mechanical cardiac support. The INTERMACS-score allows for a superior definition of the disease stage and helps guiding further diagnostic and therapeutic procedures. Therapeutic interventions include short-term use of intravenous inotropes, ultrafiltration, percutaneous and surgical cardiac assist-devices and cardiac transplantation. Integrated units at specialized centers, as for example an Advanced Heart Failure Unit, are increasingly needed to cope with the growing prevalence and the complexity of terminal heart failure and to clinically translate the rapid technological advancements.

Schlüsselwörter

terminale Herzinsuffizienz - perkutane Herzunterstützungssysteme - chirurgische ventrikuläre Assist-Systeme - Herztransplantation - Herzinsuffizienz-Wachstation

Key words

terminal heart failure - percutaneous assist devices - surgical ventricular assist devices - cardiac transplantation - advanced heart failure unit

• Literatur

• 1 McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
• 2 Kirklin JK, Naftel DC, Kormos RL et al. The fourth intermacs annual report: 4000 implants and counting. J Heart Lung Transplant 2012; 31: 117-126
• 3 Krell MJ, Kline EM, Bates ER et al. Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. Am Heart J 1986; 112: 787-791
• 4 Mebazaa A, Nieminen MS, Packer M et al. Levosimendan vs. dobutamine for patients with acute decompensated heart failure: The SURVIVE Randomized Trial. JAMA 2007; 297: 1883-1891
• 5 Cuffe MS, Califf RM, Adams jr. KF et al. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: A randomized controlled trial. JAMA 2002; 287: 1541-1547
• 6 Costanzo MR, Saltzberg MT, Jessup M et al. Ultrafiltration is associated with fewer rehospitalizations than continuous diuretic infusion in patients with decompensated heart failure: Results from UNLOAD. J Card Fail 2010; 16: 277-284
• 7 Dixon SR, Henriques JP, Mauri L et al. A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): Initial U. S. experience. JACC Cardiovasc Interv 2009; 2: 91-96
• 8 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
• 9 Cheng JM, den Uil CA, Hoeks SE et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: A meta-analysis of controlled trials. Eur Heart J 2009; 30: 2102-2108
• 10 Sheu JJ, Tsai TH, Lee FY et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med 2010; 38: 1810-1817
• 11 Rose EA, Gelijns AC, Moskowitz AJ et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med 2001; 345: 1435-1443
• 12 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
• 13 Hertz MI, Aurora P, Christie JD et al. Registry of the International Society for Heart and Lung Transplantation: a quarter century of thoracic transplantation. J Heart Lung Transplant 2008; 27: 937-942
• 14 Mehra MR, Kobashigawa J, Starling R et al. Listing criteria for heart transplantation: International Society for Heart and Lung Transplantation guidelines for the care of cardiac transplant candidates–2006. J Heart Lung Transplant 2006; 25: 1024-1042