C-Pulse IDE Feasibility Study- A Heart Assist System

Sunshine Heart Inc. is sponsoring a prospective, multi-center trial to assess the safety and
provide indications for performance of the Sunshine Heart C-PulseTM System ("C-Pulse™").

The current need is for a counterpulsation device or method that is effective enough to make
its application appealing as a long-term implant to a large number of patients and
physicians. It must be simple and safe, with a straight-forward implant procedure, and with
long-term measurable patient benefits. Further, it would be advantageous for the
counterpulsation device to be smaller, easier to insert, ambulatory, disconnectable, and not
in the bloodstream. Such a device may be more readily adopted by a wider group of
cardiologists and surgeons, and be suitable for a wider group of people in NYHA Class III or
IV heart failure. It is important to point out that a counterpulsation device is aimed to
augment native heart function and is fundamentally different from total artificial hearts,
left ventricular assist devices and heart transplants which are meant to be a total
replacement or an alternative to the native heart. Thus, the counterpulsation device is
considered non-obligatory and not life-supporting.

Sunshine Heart, Inc has proposed C-Pulse™, a novel ambulatory, non-obligatory, non-blood
contacting extra-ascending aortic counterpulsation system. The C-Pulse™ System is designed to
be implanted without the need for cardiopulmonary bypass or extensive dissection, to be able
to be activated immediately, to augment heart function in a safe manner and to provide
sustained relief from heart failure symptoms. It can be turned off safely, and similarly, in
failure modes, is considered to have an associated low risk of death or disability, other
than the recurrence of heart failure symptoms. C-Pulse™ is not an alternative to the heart,
it is an augmentation device, and it does not preclude the use of therapies that provide full
circulatory support such as heart transplantation or LVADs.

The C-Pulse™ System consists of a counterpulsation Cuff secured around the outside of the
ascending aorta, the main blood vessel out of the heart. The Cuff and a heart signal sensing
wire are attached to an external driver. The external Driver inflates and deflates the Cuff
in sequence with the ECG signal to assist heart function and improve the pumping capacity of
the heart. The Cuff deflects the aorta in a "thumb-printing" manner which has been optimized
to minimize aortic wall strain and maximize blood volume displacement per beat. The C-Pulse™
System is non-blood contacting, simple to insert, and can be turned on and off as required;
all natural blood pathways are maintained - there is no exposure of foreign material to the
bloodstream.

Inclusion Criteria:

- Patient has ACC/AHA Stage C heart failure and remains in NYHA Class III - ambulatory
Class IV despite optimal medical therapy.

- ACE inhibitor or ARB (Angiotensin Receptor Blocks) at least 30 days preceding implant
or nitrate/hydralazine at the investigators discretion

- Beta-blocker for at least 90 days and stable for 30 days preceding implant

- Patient has left ventricular ejection fraction (LVEF) ≤ 35%

- Patient has had Cardiac Resynchronization Therapy (CRT) for at least 90 days prior to
enrollment or is not indicated for a CRT device

- Patient has had an implanted cardio-defibrillator (ICD) at least 30 days prior to
enrollment or is not indicated for ICD implantation.

- Patient is at least 18 years of age and not older than 75 years

- Patient six minute hall walk assessment between 100-350 meters

- Patient understands the nature of the procedure, is willing to comply with associated
follow-up evaluations, and provide written informed consent prior to the procedure

Exclusion Criteria:

- Patient has any evidence of:

- Ascending aortic calcification on posterior-anterior or lateral chest x-ray at
initial screening OR

- Atherosclerotic ascending aortic disease, specifically intimal thickening greater
than 3mm or mobile atheroma (moderate) or mural calcification (severe) as
detected by CT scan or echocardiography (Echo)

- Patient has ascending aorto-coronary artery bypass grafts, history of aortic
dissection, Marfans disease or other connective tissue disorder or has had an aortic
root replacement

- Patient aorta not conforming to specified dimensional constraints defined by CT scan,
most specifically mid ascending aortic outside diameter less than 29mm or greater than
40mm

- Patient has severe mitral valve incompetence, grade 4+

- Patient has moderate to severe aortic valve incompetence, grade 2-4+

- Patient has systolic blood pressure less than 90 or greater than 140 mmHg

- Patient has a Serum Sodium less than 130 mEq/L

- Patient has a Estimated Glomerular Filtration Rate (GFR) less than 40 ml/min/1.73m2

- Patient has any two of three of Bilirubin, Aspartate Aminotransferase (AST), Alanine
Aminotransferase (ALT) greater than three times upper limit of normal

- Patient has a serum Albumin less than 3.0 g/dL

- Patient has Body Mass Index (BMI) less than 18 or greater than 40 kg/m2

- Men with Peak Oxygen Uptake (VO2) of greater than 18 ml/kg/min or less than 10
ml/kg/min OR -Women with Peak VO2 of greater than 16 ml/kg/min or less than 9
ml/kg/min

- Patient has any active infection

- Patient has had a myocardial infarction (MI), stroke, transient ischemic attack (TIA),
cardiac or other major surgery, in the 90 days prior to enrollment

- Patient has severe Chronic Obstructive Pulmonary Disease (COPD) as evidenced by Forces
Expiratory Volume (FEV1) less than or equal to 0.9 L/min

- Patient requires a concomitant surgical procedure [i.e. coronary artery bypass graft
(CABG), Valve repair]

- Patient is supported with a left ventricular assist device or IABP

- Severe Right Heart Dysfunction with systemic venous congestion evidenced by clinical
signs/symptoms such as Central Venous Pressure (CVP) ≥ 20 mmHg, Cardiac Index (CI) <
2.0 l/min./m2, elevated liver function tests beyond three time the upper limit of
normal and presence of ascites

- Patient has reversible causes of heart failure that may be remedied by conventional
surgery or other intervention

- Patient is pregnant; Note: Negative pregnancy test required in all women of child
bearing potential

- Patient has any other condition that, in the opinion of the investigators, would
disqualify the patient for inclusion in the study, limits survival to less than one
year, or not permit valid consideration

- Patient is currently enrolled or has participated in the last 30 days in another
therapeutic or interventional clinical study that is likely to confound study results

- Patient has symptomatic Carotid artery disease or asymptomatic disease with a stenosis
greater than 70%.