[Mechanical cardiac assist systems in intensive care].

Abstract

The indications for the use of mechanical cardiac assist-devices are sudden death, cardiogenic shock, severe coronary ischemia and high-risk PTCA. Among the cardiac assist-devices, currently available for cardiologists and cardiac surgeons, are the Intraaortal Balloon Pump (IABP), the implantable turbine-pump, the percutaneous cardiopulmonary support (PCPS), centrifugal pumps which are connected via a thoracotomy and intra- and extrathoracic total artificial hearts. It is easy to position the IABP, which can be continuously used over the course of several days. In the case of cardiogenic shock, the pump should be implanted as soon as possible, in order to facilitate revascularisation procedure in a patient with ischemic heart disease. By this procedures the survival rate of ischemic cardiogenic shock has been raised from 20% to 60%. However, the IABP does not prove supportive in the case of an MI without shock or in high-risk PTCA. The implantable turbine pump (Hemopump TM) is available in 3 configurations, ranging in external size from 14 F to 26 F. Of these, only the 14 F pumps can be implanted percutaneously by a Seldinger technique, whereas the bigger pumps require arteriotomy or thoracotomy for placement. The pump-rates of these systems reach from 2.0 l/min to 4.5 l/min. These pumps are used in high-risk PTCA as well as CABG-surgery without cardiopulmonary support, but are still currently in a test phase. However, at this point, it is still too early to finally evaluate the clinical importance of these systems. The percutaneous cardiopulmonary support (PCPS) has a major advantage over all other assist device systems, as it completely replaces the circulation. Therefore, PCPS is especially indicated in cardiac arrest, because it can be inserted very quickly, even without having to interrupt resuscitation. A second indication is high-risk PTCA, where it can be used also as a stand-by system. A study with 801 patients, investigating the use of this system in high-risk PTCA, resulted in a hospital mortality of 6.9%. In therapy-resistant circulatory arrest, approximately 30% of patients could be saved with this system, provided that there is a very quick access to it, as there is for example in the cardiac cath lab. Centrifugal pumps, which are inserted via a thoracotomy, and artificial hearts have become very important and are now used routinely in cardiac surgery to support patients, who have developed therapy-refractory heart failure, and in transplantation-surgery as "bridging to transplant". These systems, however, bear the complications of hemorrhage and thromboembolism.(ABSTRACT TRUNCATED AT 400 WORDS)