Download PDF
Dtsch Med Wochenschr 2017; 142(04): 282-289
DOI: 10.1055/s-0042-103708
Review
© Georg Thieme Verlag KG Stuttgart · New York

Mechanische Herzunterstützungssysteme in der kardiologischen Rehabilitation

Cardiac Rehabilitation in Patients with Mechanical Circulatory Support
Eike Langheim
1   Reha-Zentrum Seehof, Teltow
,
Nils Reiss
2   Schüchtermann-Klinik, Bad Rothenfelde
,
Carsten Cordes
3   Gollwitzer-Meier-Klinik, Bad Oeynhausen
,
Ernst Knoglinger
4   Kirchberg-Klinik, Bad Lauterberg
,
Johannes Glatz
1   Reha-Zentrum Seehof, Teltow
,
Detlev Willemsen   *
2   Schüchtermann-Klinik, Bad Rothenfelde
› Author Affiliations
Further Information

Publication History

Publication Date:
24 February 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Hintergrund Herzinsuffizienz in einem terminalen Stadium kann häufig nur mit einer Herztransplantation oder mit einem ventricular assist Device (VAD) behandelt werden. Die immer häufiger durchgeführte Implantation eines VAD wird wegen des bestehenden Organmangels zunehmend auch als dauerhafte Therapie gewählt.

Problem Die zunehmende Therapie mit einem VAD führt zu einem erhöhten Bedarf an Rehabilitationsangeboten. Die Entwicklung entsprechender Standards für diese Patientengruppe ist daher notwendig. Bisher sind nur Erfahrungen einzelner Zentren mit kleinen Patientenzahlen veröffentlicht. Leitlinien zu diesem Thema liegen nicht vor.

Ergebnisse Eine Arbeitsgruppe der Deutschen Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauf-Erkrankungen (DGPR) hat ein Konsensuspapier [1] entwickelt, um Stellung zu Hintergründen und Abläufen der Rehabilitation mit einem VAD zu beziehen. Dabei wurden indikationsspezifische Probleme analysiert und Strategien erarbeitet. Die wichtigsten Aspekte der Rehabilitation mit dem Ziel einer möglichst sicheren Teilhabe am Alltagsleben sind hier zusammenfassend dargestellt.

Abstract

Background Heart failure in a terminal stage is usually treated with a heart transplant or with implantation of ventricular assist devices (VAD). VAD treatment is increasingly chosen as a permanent therapy.

Problem The growing number of VAD implants leads to an increased need for rehabilitation programs. The development of standards is essential. So far only a few single center reports with a limited number of patients have been published. Guidelines on this subject are not available.

Results A working group of German rehabilitation physicians was installed in order to analyze the problems and to develop strategies for the process of rehabilitation of VAD-patients, ending in a consensus statement [1].The most important aspects of rehabilitation aiming at the safest possible participation in everyday life with a VAD are summarized here.

Schlüsselwörter

Ventricular assist device - VAD - kardiologische Rehabilitation - Teilhabe

Key words

ventricular assist device - VAD - cardiac rehabilitation - participation

* Weitere Beteiligte s. am Ende des Beitrags.


 

  • Literatur

  • 1 Willemsen D. Cordes C. Bjarnason-Wehrens E. et al. Rehabilitationsstandards für die Anschlussheilbehandlung und allgemeine Rehabilitation von Patienten mit einem Herzunterstützungssystem (VAD-ventricular assist device). Clin Res Cardiol 2016; 11: 2-49
    PubMedGoogle Scholar
  • 2 Statistisches Bundesamt. Gesundheit. Diagnosedaten der Patienten und Patientinnen in Krankenhäusern (einschl. Sterbe- und Stundenfälle). 2013 https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/DiagnosedatenKrankenhaus2120621117004.pdf?__blob=publicationFile Stand 13.05.2015
    PubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Kirklin J. Naftel D. Pagani F. et al. Seventh INTERMACS annual report: 15000 patients and counting. J Heart Lung Transplant 2015; 34: 1495-1504
    CrossrefPubMedGoogle Scholar
  • 5 Strüber M. Meyer Anne L. Malehsa D. Situation der Herztransplantation und Weiterentwicklung von Kunstherzen. Dtsch Arztebl Int 2009; 106: 471
    PubMedGoogle Scholar
  • 6 Krabatsch T. Potapov E. Soltani S. et al. Ventrikuläre Langzeitunterstützung mit implantierbaren kontinuierlichen Flusspumpen. Auf dem Weg zum Goldstandard in der Therapie der terminalen Herzinsuffizienz. Herz 2015; 40: 231-239
    PubMedGoogle Scholar
  • 7 Feldman D. Pamboukian SV. Teuteberg JJ. et al. The 2013 International Society for Heart and Lung Transplantation Guidelines for mechanical circulatory support: executive summary. J Heart Lung Transplant 2013; 32: 157-187
    CrossrefPubMedGoogle Scholar
  • 8 Corra U. Pistono M. Mazzani A. Cardiovascular prevention and rehabilitation for patients with ventricular assist device From exercise therapy to long-term therapy Part I: exercise therapy. Monaldi Arch Chest Dis 2011; 76: 27-32
    PubMedGoogle Scholar
  • 9 Pistono M. Corra U. Gnemmi M. Cardiovascular prevention and rehabilitation for patients with ventricular assist device. From exercise therapy to long-term therapy Part II: Long-term therapy. Monaldi Arch Chest Dis 2011; 76: 136-114
    PubMedGoogle Scholar
  • 10 Buck T. Breithardt O. Faber L. et al. Manual zur Indikation und Durchführung der Echokardiografie. Clin Res Cardiol Suppl 2009; 4: 3-51
    CrossrefPubMedGoogle Scholar
  • 11 Ammar K. Umland M. Kramer C. et al. The ABCs of left ventricular assist device echocardiography: a systematic approach. Eur Heart J – Cardiovasc Imag 2012; 13: 885-899
    PubMedGoogle Scholar
  • 12 Estep J. Stainback R. Little S. et al. The role of echocardiography and other imaging modalities in patients with left ventricular assist devices. J Am Coll Cardiol Cardiovasc Imag 2010; 3: 1049-1064
    PubMedGoogle Scholar
  • 13 Topilsky Y. Maltais S. Oh J. et al. Focused review on transthoracic echocardiographic assessment of patients with continuous axial left ventricular assist devices. Cardiol Res Pract 2011; 2: 1-11
    PubMedGoogle Scholar
  • 14 Rasalingam R. Johnson S. Bilhorn K. et al. Transthoracic echocardiographic assessment of continuous-flow left ventricular assist devices. J Am Soc Echo 2011; 24: 135-148
    CrossrefPubMedGoogle Scholar
  • 15 Corrà U. Piepoli MF. Adamopoulos S. et al. Cardiopulmonary exercise testing in systolic heart failure in 2014: the evolving prognostic role: a position paper from the committee on exercise physiology and training of the heart failure association of the ESC. Eur J Heart Fail 2014; 16: 929-941
    CrossrefPubMedGoogle Scholar
  • 16 Loyage-Rendon RY. Plaisance EP. Arena R. et al. Exercise physiology, testing and training in patients supported by a left ventricular assist device. J Heart Lung Transplant 2015; 34: 1005-1006
    CrossrefPubMedGoogle Scholar
  • 17 Scheiderer R. Belde C. Schwab D. et al. Exercise guidelines for inpatients following ventricular assist device placement: a systematic review of the literature. Cardiopulm Phys Ther J 2013; 24: 35-42
    CrossrefPubMedGoogle Scholar
  • 18 Wells C. Physical therapist management of patients with ventricular assist devices: Key considerations for the acute care physical therapist. Phys Ther 2013; 93: 266-278
    CrossrefPubMedGoogle Scholar
  • 19 Piepoli M. Conraads V. Corrà U. et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail 2011; 13: 347-357
    CrossrefPubMedGoogle Scholar
  • 20 Shepherd J. Wilding C. Occupational therapy for people with ventricular assist devices. Aust Occup Therap J 2006; 53: 47-49
    PubMedGoogle Scholar
  • 21 Borg G. Anstrengungsempfinden und körperliche Aktivität. Dtsch Ärztbl 2004; 101: 840-845
    PubMedGoogle Scholar
  • 22 Hayes K. Leet A. Bradley S. et al. Effects of exercise training on exercise capacity and quality of life in patients with a left ventricular assist device: A preliminary randomized controlled trial. J Heart Lung Transplant 2012; 31: 729-734
    CrossrefPubMedGoogle Scholar
  • 23 Bunzel B. Roethy W. Znoj H. et al. Psychological consequences of life-saving cardiac surgery in patients and partners: measurement of emotional stress by the Impact of Event Scale. Stress and Health 2008; 24: 351-363
    CrossrefPubMedGoogle Scholar
  • 24 Vierecke J. Kaufmann F. Schweiger M. et al. Erste Maßnahmen und Verhalten bei Störungen eines Kunstherzsystems. Notfall Rettungsmed 2011; 14: 635-646
    CrossrefPubMedGoogle Scholar
  • 25 Wilson SR. Givertz MM. Stewart GC. et al. Ventricular assist devices the challenges of outpatient management. J Am Coll Cardiol 2009; 54: 1647-1659
    CrossrefPubMedGoogle Scholar
  • 26 Mano A. Fujita K. Uenomachi K. et al. Body Mass Index is a Useful Predictor of Prognosis After Left Ventricular Assist System Implantation. J Heart Lung Transplant 2009; 28: 428-433
    CrossrefPubMedGoogle Scholar
  • 27 Musci M. Loforte A. Potapov EV. et al. Body mass index and outcome after ventricular assist device placement. Ann Thor Surg 2008; 86: 1236-1242
    CrossrefPubMedGoogle Scholar
  • 28 Montgomery T. Cohen A. Garnick J. et al. Nutrition Assessment, Care, and Considerations of Ventricular Assist Device Patients. Nutr Clin Pract 2012; 27: 352-362
    CrossrefPubMedGoogle Scholar
  • 29 Milano C. Simeone A. Mechanical circulatory support: devices, outcomes and complications. Heart Fail Rev 2013; 18: 35-53
    CrossrefPubMedGoogle Scholar
  • 30 Hannan M. Husain S. Mattner F. et al. Working formulation for the standardization of definitions of infections in patients using ventricular assist devices. J Heart Lung Transplant 2011; 30: 375-384
    CrossrefPubMedGoogle Scholar
  • 31 Pauwaa S. Bhat G. Ventricular Assist Device-Specific Infections. Shuhaiber J. (Hrsg) Ventricular Assist Devices. Rijeka, Croatia: 2011
    Google Scholar
  • 32 Nienaber J. Kusne S. Riaz T. et al. Clinical Manifestations and Management of Left Ventricular Assist Device-Associated Infections. Clin Infect Dis 2013; 57: 1438-1448
    CrossrefPubMedGoogle Scholar
  • 33 Slaughter M. Pagani F. Rogers J. et al. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant 2010; 29: S1-S39
    CrossrefPubMedGoogle Scholar
  • 34 Emani S. Pagani F. Eckman P. et al. Hit the road: A multicenter evaluation of driving with LVADs. J Heart Lung Transplant 2013; 32: S98
    PubMedGoogle Scholar
  • 35 Baskett R. Crowell R. Freed D. et al. Canadian Cardiovascular Society Focused Position Statement Update on assessment of the cardiac patient for fitness to drive: fitness following left ventricular assist device implantation. Can J Cardiol 2012; 28: 137-140
    CrossrefPubMedGoogle Scholar
  • 36 Coyle L. Martin M. Kurien S. et al. Destination Therapy: Safety and Feasibility of National and International Travel. ASAIO J 2008; 54: 172-176
    CrossrefPubMedGoogle Scholar
  • 37 MacIver J. Ross H. Quality of life and left ventricular assist device support. Circulation 2012; 126: 866-874
    CrossrefPubMedGoogle Scholar
  • 38 Bruce C. Smith M. McCullough L. Clarification of the intent of ventricular assist devices before patient consent. J Thorac Cardiovasc Surg 2013; 145: 1423-1425
    CrossrefPubMedGoogle Scholar
  • 39 Brush S. Budge D. Alharethi R. et al. End-of-life decision making and implementation in recipients of a destination left ventricular assist device. J Heart Lung Transplant 2010; 29: 1337-1341
    CrossrefPubMedGoogle Scholar
  • 40 Bundesärztekammer. Grundsätze der Bundesärztekammer zur ärztliche Sterbebegleitung. Dtsch Ärztebl 2011; 108: A346-A348
    PubMedGoogle Scholar