MESSAGES to the PATIENTS

Dear Reader,

If I summarize the information you have already reviewed in this web-site, almost 30 years experience all over the World proved that ECP is an easily applied, non-invasive and safe therapy for patients with coronary artery disease; it  increases blood flow and improves function of the heart and many organs, it leads to decrease in the necessity of drug use, hospital admissions and invasive interventions, thereby it improves health status and the quality of life and prolongs life expectancy by preventing and/or delaying the complications.

When you learn all this information, the question may arise in your mind that, if ECP is such an excellent treatment, why is it a less known and less recommended therapy by the doctors in our country? I will try to answer:

Among the modalities widely used nowadays in the treatment of patients with coronary artery disease, bypass surgery  started in 1964 and balloon angioplasty started in 1977. In comparison to them, ECP is a new therapy, even though ECP applications started in China about 30 years ago,  it was recognized and its world wide application started after FDA approval in USA in 1995.

Intensive research takes place with enormous investments all over the world, for the treatment of patients with coronary artery disease, and the obtained technological developments concerning new drugs, bypass surgery and balloon-stent applications are offered to the benefit of medicine with impressive promotion programs.

There is a prejudice that the disease of such an important organ like the heart could be treated better with high technological methods even if they are invasive and carry some risks, and an easily applied, simple-looking and free-of-risk modality such as ECP may not provide enough benefit. I frequently witness that, because of this prejudice, most of my colleagues unfortunately refuse this therapy even without reviewing the research studies and updated information about ECP treatment.

With the same prejudice, most of the cardiology centers make great investments  spending more then million US dollars in the country to set up operating rooms and intensive care units for bypass surgery and catheterization laboratories for balloon-stent applications, but hesitate to set up an ECP unit spending significantly less than this amount.

In addition, cardiac operations and other high technological invasive procedures are successfully carried out in many centers in our country, so that we all appreciate and are proud of witnessing the successful results and leading comments of our colleagues in international cardiology journals and at congresses. Therefore, well experienced invasive cardiologists and cardiac surgeons in the country, prefer to continue in treating cardiac patients in their centers with the technological facilities that are already available and with their expertise; they do not consider ECP as another treatment option, so they do not even mention about ECP to their patients.

But unfortunately, atherosclerotic process which leads to narrowing and occlusions of the coronary arteries causing coronary heart disease is a progressive disease. Even though, bypass operations are successfully accomplished, new narrowing and even total occlusions occur on bypassed arteries, on grafts and on the other vessels. Also, after successful balloon-stent application, new narrowing and even total occlusion occur at the opened point of the significant narrowing inside the stent or on the other vessels.

New narrowing and occlusions after balloon-stent applications and bypass operations, may sometimes occur quite early, even 3-6 months after these procedures, in high-risk patients, in patients with small coronary arteries and inadequate collateral vessels, and in diabetic subjects. For this reason, after these invasive treatments  and before the development of new narrowing, the application of ECP therapy, increasing blood flow through all the arteries and enlarging them, prevents and/or delays new narrowing and provides a long lasting beneficial effect after these troublesome treatments.

Unfortunately, as the ECP treatment units are very limited in number in our country, such a preventive use is not possible yet and ECP treatment is considered after narrowing and /or occlusion of many vessels including the bypassed and stented ones and when there is no possibility for treatment with any other modalities.

In my medical career, I usually preferred to work and specialize on non-invasive and non-risk diagnostic and treatment modalities. With the same reason, I got interested in ECP treatment 8 years ago. Since then, following the published research studies closely, visiting world wide known ECP centers to observe their applications and meeting with the experts and also with my personal experience for over 7 years on ECP application, I am convinced about the safety and efficiency of ECP treatment. In every occasion, I share all my knowledge and experience with my colleagues and I believe ECP treatment will become a widely used and indispensable  therapy in the near future in our country.

My statements above should not give any impression that I am against invasive interventions. After assessing the general health and coronary arteriography of patients who consult me, I refer them either to balloon-stent application or to bypass surgery or apply them ECP therapy, according to whichever is appropriate for them, as all those treatment facilities are present at the center I work..

You can also learn which treatment modality is suitable for you or for your patient, consulting a cardiologist who has enough knowledge and experience on ECP therapy.

For the decision if ECP treatment is suitable for you without any contraindications, this consultation should include complete physical examination, review of existing documents,  and of requested additional ones.

Anybody who has coronary artery disease or risk factors, either had any invasive intervention in the past such as coronary artery bypass surgery and/or balon-stent application or not, can get benefit from ECP therapy, as long as there are no contraindications. This can be concluded by the abovementioned investigations.

I wish good health to your heart and vessels

Prof. Dr. Günsel Şurdum Avcı