Therapeutic value of muscular counterpulsation after coronary bypass grafting operation.

OBJECTIVE: Coronary artery bypass grafting continues to be the operation of choice in patients with severe multiple coronary artery disease. However, there are several unresolved issues such as treatment of postoperative heart failure following bypass surgery. There is worldwide interest in evaluating new treatment methods for this condition. The objective is to determine the effect of a new external, bioassisted circulation-muscular counterpulsation (MCP) method in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting (CABG). METHODS: Fifty patients (age 54 +/- 8) undergoing CABG were included in the present analysis. Patients were randomized into two groups: A control group (n = 20) receiving standard postoperative treatment without counterpulsation and a treatment group (n = 30) undergoing MCP with a cardio-synchronized pulse generator using stimulation electrodes on the lower extremities. Treatment was 30 minutes daily for the eight initial postoperative days in addition to standard therapy. In all patients, a resting electrocardiogram (ECG), two-dimensional echocardiography, and impedance plethysmography of the forearm were carried out pre-CABG and on the eighth postoperative day. RESULTS: Follow-up was completed in 94% of the patients. Two patients of the control and one of the treatment group refused follow-up examination. MCP treatment resulted in a 36% decrease of systemic vascular resistance (p < 0.001) compared to a 16% decrease (p = 0.011) in the control group. Postoperative complications occurred in one (3%) patient of the treatment group and in seven (39%) patients of the control group. Compared to the control group, patients in the treatment group had a 28% shorter postoperative hospital stay (12.0 +/- 4.6 days) than in the control group (16.8 +/- 4.4 days) (p < 0.001). CONCLUSIONS: MCP represents a new, noninvasive, ECG-triggered circulation support system, which is effective for achieving hemodynamic improvement via afterload reduction. The use of MCP decreases postoperative complications and significantly shortens the hospital stay.

Acute Beneficial Effects of Muscular Counterpulsation in Patients with Coronary Heart Diseases.

This prospective pilot study was designed to investigate the acute hemodynamic effects and clinical applicability of muscular counterpulsation (MCP), a one-shot procedure for biomechanical circulatory support. The study included 17 consecutive patients with coronary artery disease (CAD) and impaired ejection fraction (EF ≤45%) who underwent elective coronary artery bypass grafting (CABG). Patients were divided into control ( n = 7) and treatment ( n = 10) groups. MCP was applied through adhesive skin electrodes to the thighs and calves with a battery-powered, portable, ECG-triggered device for 15 minutes prior to general anesthesia. Standard ECG and invasive hemodynamic data were obtained from all patients. MCP was well tolerated in all patients, with no complications. Patients receiving MCP exhibited better cardiac function as indicated by reduced systemic vascular resistance and an augmented cardiac stroke index (+10%), which was maintained over time. After inducing general anesthesia via endotracheal intubation, the treatment group exhibited a reduced after-load (systemic vascular resistance index -28% and mean arterial pressure -10%) with increased left ventricular efficiency (stroke index/left ventricular stroke work index, +22%). Our findings indicate that MCP method was safe and easy to use in this patient population. In conclusion, a one-shot application of MCP prior to anesthesia was associated with an improvement in cardiac pump function and myocardial contractility.