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Enhanced external counterpulsation--a therapeutic option for patients with chronic cardiovascular problems.

EECP is a non-invasive outpatient treatment for cardiovascular disease refractory to medical and/or surgical therapy. It has been cleared by the Food and Drug Administration for the treatment of a variety of cardiac conditions including congestive heart failure and chronic stable angina. A course of therapy consists of 35 one-hour treatments given once or twice daily. Augmented diastolic pressure and retrograde flow improve myocardial perfusion, while systolic unloading reduces cardiac workload and oxygen requirements. As a result of this treatment, most patients experience increased time to onset of ischemia, increased exercise tolerance, a reduction in the number and severity of anginal episodes, and improved quality of life. Evidence has been presented that this effect lasts well beyond the immediate post-treatment period with some patients symptom-free for several years. Because patients principally seek medical care to live longer or feel better, heart programs need to offer their patients the latest medical advances which have the potential of improving patient survival and health status (symptoms, functioning, and quality of life). Heart programs face a challenging economic future. Increased competition makes it necessary to implement strategies for market differentiation. Those programs most attuned to what their patients define as critical to quality would be most likely to succeed. Over the past decade, there have been a growing number of patients with chronic angina who have exhausted the standard revascularization armamentarium. Because coronary artery bypass grafts occlude and restenosis occurs at angioplasty sites, many patients no longer have suitable coronary anatomy for additional procedures. Also, as the population ages, the proportion of patients with diffuse coronary disease, congestive heart failure, significant co-morbid illness, and poor functional status increases. The incapacitating effects of angina on patients' abilities to work, maintain regular social interactions, and participate in the usual activities of daily living are well described. In spite of the ongoing successes of catheter-based revascularization techniques, the population of patients with intractable angina continues to grow; and ironically, advancements in medical therapy have resulted in an increasing number of patients who are living with severe left ventricular dysfunction and congestive heart failure. Recent studies have estimated that approximately 5-15% of patients undergoing coronary angiography may be considered to have advanced coronary artery disease. Considering that 1,713,000 cardiac catheterizations were performed in 1996 in the United States, approximately 100,000-250,000 patients per year may be eligible for newer treatments for coronary artery disease. More recent statistics in the AHA Heart and Stroke Update report that in 2001, nearly one million patients had coronary artery bypass graft surgery or percutaneous coronary intervention, (Figure 1). Of these, 125,650 patients experienced persistent angina.

Activities of Daily Living↗
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[Results of the use of intraaortic balloon counterpulsation in patients with perioperative myocardial infarct].

The results of complex intensive therapy of cardiogenic shock have been studied in 17 patients with acute myocardial infarction developed as a complication of reconstructive surgery for ischemic heart disease. Complex therapy of cardiogenic shock included the use of intraaortic balloon contrapulsation, adrenomimetic agents, controlled lung ventilation and other intensive care procedures. 11 patients (64.7%) recovered from cardiogenic shock, 4 of them survived and were discharged from hospital. In 6 patients (35.3%) the combined use of adrenomimetics and intraaortic balloon contrapulsation had no effect. The results of intensive care procedures were shown to depend on the size of perioperative myocardial infarction, which affected the severity of hemodynamic disturbances and duration and efficacy of complex intensive therapy of cardiogenic shock. The use of intraaortic balloon contrapulsation in cardiogenic shock resistant to adrenomimetic agents led to temporary hemodynamic stabilization without improving the prognosis.

Adult↗
PubMedDate not supplied

The intraaortic counterpulsation balloon in cardiac surgery. The importance of opportune indication.

The results with the use of this device in patients who develop Low Cardiac Output Syndrome after cardiac surgery with extracorporeal circulation are analyzed. Special emphasis is given to the development of the opportune indication of this procedure, on the basis of a comparison of the results of the first few years to the most recent ones. Finally, the advantages of the prophylactic use of the Intraaortic Balloon Pump are commented.

Adult↗