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Extrakardiale Operationen bei Patienten mit permanentem linksventrikulärem Assist Device

  • G. FärberEmail author
  • T. Doenst
Kardiotechnik/EKZ
  • 125 Downloads

Zusammenfassung

Die Versorgung terminal herzinsuffizienter Patienten mit einem permanenten linksventrikulären Herzunterstützungssystem („left ventricular assist device“, LVAD) hat sich zu einer weit verbreiteten und etablierten Therapie entwickelt. Bedingt durch die stete Weiterentwicklung dieser Therapieform und den Rückgang an Herztransplantationen steigt die Zahl der LVAD-Patienten kontinuierlich an. Somit gewinnt die operative Versorgung extrakardialer Erkrankungen bei zunehmender Unterstützungsdauer am LVAD an Bedeutung. Hauptsächlich verteilen sich die Eingriffe auf die Fachbereiche der Gastroenterologie, Allgemein- und Viszeralchirurgie sowie Herzschrittmacher und ICD/CRT systembezogene Chirurgie. Prinzipiell können alle weiteren Fachbereiche involviert sein. Extrakardiale Operationen sind bei LVAD-Patienten mit einer gesteigerten Morbidität und Letalität assoziiert; daher gelten die Betroffenen als Hochrisikokollektiv. Das erhöhte Risiko beruht auf der Grunderkrankung und den weiteren, meist zahlreichen Komorbiditäten sowie auf der Notwendigkeit zur Antikoagulation und der durch das LVAD selbst verursachten Koagulopathie. Perioperativ auftretende schwerwiegende Blutungen stellen die führende Komplikation dar. Bei sorgfältiger interdisziplinärer Vorbereitung, prä-, intra- und postoperativer Anpassung des Monitoring, Planung der operativen Strategie und spezieller Überwachung der Hämostaseologie lassen sich extrakardiale Eingriffe an erfahrenen VAD-Zentren mit akzeptablem Risiko durchführen. Im vorliegenden Beitrag werden die wesentlichen Themenkomplexe diskutiert, die bei der Durchführung extrakardialer Operationen zu berücksichtigen sind. Darüber hinaus wird eine Literaturübersicht zum Thema geliefert.

Schlüsselwörter

Intraoperatives Monitoring Hämodynamik Antikoagulation Blutung Antibiotikaprophylaxe 

Non-cardiac surgery in patients with long-term left ventricular assist device

Abstract

The implantation of left ventricular assist devices (LVAD) has become a widespread and established therapeutic option for treating terminal heart failure patients. Continuous improvement of this treatment and shortage of donor organs in Germany, has led to an increase in the number of patients being supported with a LVAD. Therefore, it is inevitable that a number of these patients will require non-cardiac surgery as their years of survival increases. The most frequent procedures are endoscopic interventions, general and visceral surgery, pacemakers and implantable cardioverter defibrillator (ICD) cardiac resynchronization therapy (CRT) related procedures; however, all other disciplines can principally be involved. Patients with a LVAD undergoing non-cardiac surgery have an increased risk for morbidity and mortality and therefore represent a high risk population. The increased risk of LVAD patients is caused by the underlying disease and often further comorbidities combined with the need for anticoagulation and the device-related coagulopathy. Not surprisingly, severe bleeding represents the major perioperative complication. Meticulous preparation and close team work including preoperative, intraoperative and postoperative adjustment of patient monitoring, surgical strategy as well as control of hemostasis, enables non-cardiac surgery to be performed with an acceptable risk in experienced VAD centers. This article discusses the major issues regarding the performance of non-cardiac surgery in VAD patients.

Keywords

Monitoring, intraoperative Hemodynamics Anticoagulation Bleeding Antibiotic prophylaxis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Färber und T. Doenst geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum JenaFriedrich-Schiller-Universität JenaJenaDeutschland

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