ABSTRACT
In 1953, Kantrowitz and Kantrowitz conceived of a novel approach to improving coronary
blood flow to the ischemic myocardium by delaying the arterial pulse into the diastolic
period (1). They extended this principle of diastolic augmentation by stimulating a
hemidiaphragm wrapped around the distal thoracic aorta in diastole, thereby providing the
first description of an auxiliary ventricle (2). Simultaneously, Harken, working in the
Harvard Surgical Research Laboratory, hypothesized that the rapid removal of blood from
the arterial circulation during systole (and returned during diastole) could decrease the
pressure work of the heart (3). Such a device, the “arterial counterpulsator” was built by
Birtwell and saw brief clinical use but was limited by an inability to move the blood back
and forth rapidly enough without excessive hemolysis (4). Clauss (5) and Moulopoulos
(6), working independently, developed the use of an inflatable chamber within the aorta as
an arterial counterpulsator. In 1968, Kantrowitz reported the successful resuscitation of a
patient with medically refractory cardiogenic shock following a myocardial infarction
using helium to rapidly inflate and deflate an intra-aortic balloon placed via the femoral
artery (without the need for thoracic surgery) (7). The Datascope Corporation developed a
percutaneously insertable device in 1979, introducing the modern era of emergent arterial
counterpulsation (8). IABP has now become standard equipment in all institutions that
offer advanced cardiovascular care due to its ease of placement, cost, availability,
simplicity, and clinical track record. Its effectiveness has been well-documented and
counterpulsation is now considered a Class I indication by the American College of
Cardiology and the American Heart Association for the management of pharmacologi-
cally resistant cardiogenic shock (9). IABP is the most commonly used circulatory assist
device in the world. The clinical use of IABP has also evolved rapidly and its
contemporary use includes the support of the circulation during percutaneous coronary
intervention, cardiac surgical procedures, and bridging of patients with both acute and
chronic heart failure to more definitive therapies. Recent and future developments in
counterpulsation technology are now testing the effectiveness and feasibility of using
noninvasive counterpulsation, EECP, as well as surgically implanted permanent devices
for the chronic management of heart failure.
