J. ROSEN WEIG AND S. CHATTER JEE 
139 
ease and large obstructions can be made. Sub- 
sequently, it is possible to go on to something 
definitive like saphenous vein bypass which was 
done several times at Massachusetts General 
Hospital. I'm still selling myself down the drain 
because I believe, as you do, that there will be 
a very significant number of those who will go 
on in spite of these efforts to develop further 
cardiogenic shock and cannot be bailed out; 
that is where my interest in long-term assist- 
ance arises. Would you like to comment? 
Dr. Chatterjee : Yes. I'd like to comment on 
our experience in counterpulsation. We have 
done arterial counterpulsation in twelve cases, 
out of which four patients have survived. The 
longest period of survival is four years. 
Dr. Sawyer: What parameter was used to 
determine whether the patient was in cardio- 
genic shock? 
Dr. Chatterjee: No palpable pressure and 
low cardiac output — complete clinical signs of 
cardiogenic shock. We have also treated nine 
cases by balloon pumping and salvaged five 
patients; one of these died after six months. So 
there are four living patients. 
Dr. Sawyer: We have seen a number of pa- 
tients considered to be in cardiogenic shock; 
they were salvaged by pharmacotherapy and it 
was found, in each instance when they were 
angiogrammed, that they had at most one se- 
vere coronary arterial occlusion. All those pa- 
tients who died had autopsies done on their 
coronary arteries, and they were all found to 
have very severe coronary arterial disease ; they 
were all found to have a very acute or a very 
poor collateral formation; they were all found 
to have essentially no patent proximal coronary 
artery — a very severe three vessel disease. I 
maintain that the reason why we are all here is 
because everybody here concedes that the ma- 
jority of these patients are going to need one 
of three things done. (1) They must have re- 
vascularization of what's left of their myo- 
cardia; (2) they must have the existing dead 
myocardia removed so that, hopefully, enough 
left ventricle is left to act as an effective pump; 
or (3) as Dr. LaFarge has now maintained on 
the basis of his own actions for the past ten 
years, they should have either an auxiliary or 
a replacement pump. 
Chairman : I am not trying to say that coun- 
terpulsation is the ultimate answer, but it prob- 
ably can be used as a temporary support in 
many of these cases and probably in some pa- 
tients who do not require it. 
Dr. Sawyer : We agree. 
Chairman : I'd like to conclude on that note 
also, i.e., that we need both types of support, as 
you will see over the years. We need the parallel 
development of both, including the parallel 
development of transplants. 
