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J Thorac Cardiovasc Surg 1996;112:850-851
© 1996 Mosby, Inc.

LETTERS TO THE EDITOR

A history of the valveless paraaortic counterpulsation device

First Department of Surgery
Kumamoto University School of Medicine
Kumamoto, Japan

To the Editor

I read with interest the article entitled "A Valveless High Stroke Volume Counterpulsation Device Restores Hemodynamics in Patients With Congestive Heart Failure and Intractable Cardiogenic Shock Awaiting Heart Transplantation" by Nanas and associates ¹ in the January 1996 issue of the Journal. They reported clinical experiences with implantation of a valveless paraaortic counterpulsation device. Although all patients died while awaiting heart transplantation, I would like to congratulate Dr. Nanas and his colleague for showing promising circulatory assist performance of the device in their patients.

The concept of this type of device is not so new. This letter provides a brief historical review for better understanding of valveless paraaortic counterpulsation devices used as left ventricular assist devices ( Table I ). Since the first report by Nose, Schamaun, and Kantrowitz ² in 1963, several studies of similarly designed devices have been presented in animal experiments. ^3-5 Gabby and Frater ³ demonstrated the superiority of this type of device over intraaortic balloon pumping for providing circulatory assistance in a model of acute left ventricular failure. Utoh and colleagues ⁵ demonstrated a 20% increase in the endocardial viability ratio and reported problems of systemic thromboembolism and bacterial infection in long-term calf experiments. Nanas and his colleagues began developing this type of device in 1984 ⁴ and finally applied for clinical use. ¹

References

1. Nanas JN, Lolas CT, Charitos CE, Nanas SN, Margari ZJ, Agapitos EV, et al. A valveless high stroke volume counterpulsation device restores hemodynamics in patients with congestive heart failure and intractable cardiogenic shock awaiting heart transplantation. J Thorac Cardiovasc Surg 1996;111:55-61.[Abstract/Free Full Text]
   
2. Nose Y, Schamaun M, Kantrowitz A. Experimental use of an electronically controlled prosthesis as an auxiliary left ventricle. Trans Am Soc Artif Intern Organs 1963;9:269-74.
   
3. Gabby S, Frater RW. The extra-aortic balloon counterpulsation as an assist device. Trans Am Soc Artif Intern Organs 1981;27:598-603.[Medline]
   
4. Nanas JN, Olsen DB, Hamanaka Y, Chiang B-Y, Nielsen S, Hughes S, et al. Experience with a valveless, implantable abdominal aortic counterpulsating device. Trans Am Soc Artif Intern Organs 1984;30:540-4.[Medline]
   
5. Utoh J, Whalen RL, Wilkerson BR, Fukamachi K, Harasaki H. Chronic in vivo function of a new ventricular assist device: the extracorporeal pulsatile assist device (EPAD). Int J Artif Organs 1993;16:91-5.[Medline]
   

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