Zusammenfassung
Hintergrund
Die terminale Herzinsuffizienz stellt eine der Haupttodesursachen in Deutschland dar. Auch heutzutage gilt die Herztransplantation als Goldstandard zur Behandlung der terminalen Herzinsuffizienz. Es besteht jedoch eine Diskrepanz zwischen Patienten auf der Warteliste und durchgeführten Transplantationen. Als Alternative haben die Herzunterstützungssysteme einen wichtigen Stellenwert erreicht, die Therapie ist jedoch mit Herausforderungen verbunden. Neue Systeme, aber auch innovative chirurgische Techniken tragen dazu bei, Sicherheit und Effektivität der Therapie zu verbessern.
Ziel der Arbeit
Erstellung einer Übersicht aktueller chirurgischer Innovationen in den Bereichen Herztransplantation und mechanischer Kreislaufunterstützung.
Material und Methoden
Es wurde eine Medline-Recherche zu den o. g. Themenbereichen durchgeführt.
Ergebnisse und Diskussion
Nicht nur die Anzahl der durchgeführten Herztransplantationen hat sich verändert, auch das Patientenkollektiv: Während in den Pionierzeiten der Transplantation der typische Kandidat deutlich jünger und nicht voroperiert war und ein geringeres Maß an Komorbidität zeigte, ist der heutige Patient auf der Warteliste älter, mit einem Herzunterstützungssystem versorgt und hat ein erhöhtes Risikoprofil. Moderne Methoden der Organkonservierung ermöglichen längere Transport- und Operationszeiten sowie eine bessere Beurteilung der Transplantatfunktion und Perspektiven zur Transplantatoptimierung. Im Bereich der Herzunterstützungssysteme scheint nun endlich durch die neuen Geräte ein deutlicher Fortschritt bezüglich der Reduktion der Schlaganfallrate erreicht zu werden. Aus chirurgischer Perspektive haben sich an zahlreichen Zentren weniger invasive Operationstechniken mit vielversprechenden Erstergebnissen etabliert.
Abstract
Background
End-stage heart failure is one of the leading causes of death in Germany. Cardiac transplantation is still considered the gold standard for the treatment of terminal heart failure; however, there is a discrepancy between patients on the waiting list and yearly performed transplantations. As an alternative, ventricular assist devices have achieved a high level of importance but treatment is still associated with challenges. Novel systems as well as innovative surgical techniques contribute to improving the safety and effectiveness of the treatment.
Objective
To generate an overview of current surgical innovations in cardiac transplantation and mechanical circulatory support.
Material and methods
A Medline search was conducted regarding innovations in cardiac transplantation and mechanical circulatory support.
Results and conclusion
Not only the number of yearly performed cardiac transplantations has changed but also recipient profiles. While in the pioneering era of transplantation the typical candidate was young, not previously operated on and with lower levels of comorbidities, today’s patients are significantly older, have been fitted with ventricular assist devices and have increased operative risk profiles. Modern methods of organ preservation enable longer transportation and operation times as well as an improved assessment of graft function and perspectives for graft optimization in the future. In the area of ventricular assist devices, advances in the reduction of the stroke rate seem to have been achieved by the latest generation devices. From a surgical perspective, less invasive surgical techniques with promising initial results have been established at numerous centers.
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S.V. Rojas und A. Haverich geben an, dass kein Interessenkonflikt besteht.
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Rojas, S.V., Haverich, A. Kardiales Pumpversagen: Herzunterstützungssysteme und Herztransplantation. Chirurg 90, 110–116 (2019). https://doi.org/10.1007/s00104-018-0774-3
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DOI: https://doi.org/10.1007/s00104-018-0774-3