A VALVELESS HIGH STROKE VOLUME COUNTERPULSATION DEVICE RESTORES HEMODYNAMICS IN PATIENTS WITH CONGESTIVE-HEART-FAILURE AND INTRACTABLE CARDIOGENIC-SHOCK AWAITING HEART-TRANSPLANTATION

The paraaortic counterpulsation device is a round pumping chamber with one valveless opening 20 mm in diameter and a 100 ml stroke volume. T he paraaortic counterpulsation device was implanted on the ascending a orta of three male patients with intractable cardiogenic shock. Patien ts were assisted for 4 hours and 8 and 54 days, respectively; the firs t patient died as a result of nonresponding peripheral vasodilation an d the other two died of septic shock. The two patients who were assist ed for 8 and 54 days were conscious and able to function in a limited manner during the mechanical assistance. Discontinuation of the mechan ical support for a few seconds was followed by low systolic arterial p ressure (30 to 60 mm Hg) and syncopal episodes. Biochemical tests and autopsy results in these patients showed no evidence of blood cell des truction, thrombus formation, brain infarction, or other distal emboli . In conclusion, satisfactory hemodynamic effects, excellent biocompat ibility, and simplicity of the implantation procedure in these patient s encourage the use of the paraaortic counterpulsation device as a bri dge to heart transplantation.