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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Mar 24, 2016; 6(1): 115-124
Published online Mar 24, 2016. doi: 10.5500/wjt.v6.i1.115
Continuous internal counterpulsation as a bridge to recovery in acute and chronic heart failure
Christos D Kontogiannis, Konstantinos Malliaras, Chris J Kapelios, Jay W Mason, John N Nanas
Christos D Kontogiannis, Konstantinos Malliaras, Chris J Kapelios, John N Nanas, 3rd Department of Cardiology, University of Athens School of Medicine, 11527 Athens, Greece
Jay W Mason, Cardiology Division, University of Utah, Salt Lake City, UT 84132, United States
Author contributions: Kontogiannis CD, Malliaras K and Nanas JN wrote the manuscript; Kapelios CJ and Mason JW reviewed the manuscript and provided critical input; all authors approved the final draft.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John N Nanas, MD, PhD, 3rd Department of Cardiology, University of Athens School of Medicine, 67 Mikras Asias Street, 11527 Athens, Greece. jnanas@ath.forthnet.gr
Telephone: +30-210-8236877 Fax: +30-210-7789901
Received: September 10, 2015
Peer-review started: September 10, 2015
First decision: October 16, 2015
Revised: December 27, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: March 24, 2016
Processing time: 190 Days and 11.9 Hours
Abstract

Cardiac recovery from cardiogenic shock (CS) and end-stage chronic heart failure (HF) remains an often insurmountable therapeutic challenge. The counterpulsation technique exerts numerous beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics, rendering it attractive for promoting myocardial recovery in both acute and chronic HF. Although a recent clinical trial has questioned the clinical effectiveness of short-term hemodynamic support with intra-aortic balloon pump (IABP, the main representative of the counterpulsation technique) in CS complicating myocardial infarction, the issue remains open to further investigation. Moreover, preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function, facilitating long-term weaning from mechanical support or enabling the application of other permanent, life-saving solutions. The potential of long-term counterpulsation could possibly be enhanced by implementation of novel, fully implantable counterpulsation devices.

Keywords: Counterpulsation; Recovery; Intra-aortic balloon pump; Heart failure; Cardiac remodeling; Reverse remodeling

Core tip: The counterpulsation technique induces beneficial effects on systemic hemodynamics and left ventricular mechanoenergetics. In this manner, it may facilitate myocardial recovery in acute and chronic heart failure (HF). The intra-aortic balloon pump (IABP) remains the main representative of the counterpulsation technique. Although recent data have questioned the effectiveness of short-term hemodynamic support with IABP in cardiogenic shock complicating myocardial infarction, the issue remains open to further investigation. Preliminary data suggest that long-term IABP support in patients with end-stage HF is safe and may mediate recovery of left- or/and right-sided cardiac function. Novel, fully implantable counterpulsation devices, which enable long-term counterpulsation, are described in this manuscript.