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.