Mikroembolien und zerebrale Hämodynamik nach Implantation eines linksventrikulären Assist-Devices

Zusammenfassung

Der Behandlung mit mechanischen Herzunterstützungssystemen („Kunstherz“) wird eine beachtliche Zukunftsoption für viele herzinsuffiziente Patienten vorhergesagt, zumal die Herztransplantationszahlen den Bedarf bei weitem nicht decken können. Erfolgreich sind linksventrikuläre Assist-Systeme, welche inzwischen komplett intrathorakal implantierbar sind und Patienten eine hohe Selbständigkeit ermöglichen und eine geringere Komplikationsrate als extrathorakale Systeme aufweisen. Was als Bridging-Therapie angedacht war wird zunehmend eine Endversorgung (Destination-Therapie). Die Behandlung erfordert eine intensive Nachbetreuung zur Vermeidung von Komplikationen wie Thrombosen, Blutungen oder Infektionen. Gefürchtet sind Schlaganfälle, welche den Neurologen in die akute Behandlungskette als auch in die Rehabilitation einbringen. Da MRT Untersuchungen nicht möglich sind, sind Ultraschalluntersuchungen hoch relevant. Diese erfordern Kenntnisse bezüglich des Auftretens von Mikroembolien und der veränderten zerebralen Hämodynamik. In dem Artikel werden die bisherigen Befunde vorgestellt und diskutiert.

Abstract

Treatment options with mechanical circulatory support devices of the heart have a high potential for a majority of cardiac patients with heart insufficiency. This is important in respect to the decreasing availability of donor organs for heart transplantations. Left ventricular assisted devices can be successfully implanted intracorporeally, allow the patients a high mobility and have less complications. Although the treatment was developed to bridge the critical phases before heart transplantation, nowadays LVADs are used as destination therapy. The treatment requires attention to avoid complications, such as thrombosis, bleeding or infections of the drive line. Stroke is a challenge and neurologists are involved for the acute management on stroke units and rehabilitation centres. Since MRI is a contraindication ultrasound investigations could be relevant. The ultrasound examination requires special knowledge about the detection of cerebral microemboli and the cerebral haemodynamics. We present aspects about the ultrasound results in these patients.

Schlüsselwörter

LVAD - Heartmate II - HeartWare - Mikroembolien - zerebrale Hämodynamik

Key words

LVAD - heartmate II - heartware - microemboli - cerebral haemodynamics

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