Aortic counterpulsation: C-pulse and other devices for cardiac support.

Heart failure is the leading cause of hospitalization in the USA. Despite major advances in the medical and device-related therapy including chronic resynchronization therapy for management of heart failure, significant number of patients eventually require advanced cardiac therapy including mechanical circulatory support or heart transplant. Heart transplant is a gold standard for end-stage heart failure but is limited by the donor heart shortage creating a definite need for alternative effective therapies. The earliest and most common form of mechanical circulatory support is counterpulsation therapy. Annually, more than 150,000 patients worldwide receive counterpulsation therapy for various indications including cardiogenic shock or severe left ventricular dysfunction (Nanas and Moulopoulos in Cardiology, 84:156-167, 1994) and many thousands of lives are saved each year (65 % survival) (Torchiana et al. in Journal of Thoracic and Cardiovascular Surgery, 113(4):758-764, 1997). There are different types of aortic counterpulsation devices. Here, we will give an overview of different counterpulsation devices with focus on C-Pulse device. Extra-aortic balloon counterpulsation, C-Pulse (Sunshine Heart Inc., Eden Prairie, MN), is an important and novel approach in the management of patients with advanced heart failure who remain symptomatic despite optimum medical and device-based therapy. C-Pulse is designed to provide permanent, long-term, continuous partial circulatory support for New York Heart Association class III and ambulatory class IV heart failure patients. C-Pulse is a nonblood-contacting counterpulsation using an inflatable cuff around the ascending aorta, extra-aortic balloon (EAB) counterpulsation device. A pivotal, multicenter US study to assess the safety and efficacy of C- Pulse in patient with Stage C and NYHA Class III or ambulatory Class IV heart failure is in progress.