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Percutaneous ventricular restoration therapy

Percutaneous ventricular restoration therapy

This is a new form of device therapy for heart failure. The device used is Parachute implant® (http://www.cardiokinetix.com/).

Parachute implant is an umbrella shaped device that is inserted into the left ventricle.

Pathophysiological basis of use:

–          In post MI patients there is progressive LV remodelling (progressive dilatation of the               left ventricle).

–          This dilatation of the ventricle increases the LV wall stress.

wall stress = (LV pressure  × LV diameter)÷  ( 2×LV wall thickness )

–          Increased LV wall stress increases LV afterload

–          Increased LV afterload worsens the LV dysfunction.

What the device does:

This device is useful in patients with old anterior and antero-apical infarctions and LV             dysfunction.

–          Parachute implant separates the dilated apical portion of the left ventricle from the                 normally contracting LV.

–          There by improves the LV geometry

–          Reduces the LV afterload

–          Improves LV function

Data regarding efficacy:

In a recent study presented at ESC heart failure congress,

–          There was a significant reduction in LV end-diastolic (120.8 vs 103.8) an end-systolic volumes (87.6 vs 73.2) at 12 months after parachute implant. There was significant increase in LVEF (28.4 vs 30.4).

–          Symptomatic improvement

–          Improvement in functional class

–          It might improve heart failure related admissions and mortality.

Risks:

–          Interference of the device with papillary muscles or apical chordae tendineae is unknown

–          Risks and consequences of dislocation.

–          Thrombo-embolic risk.

Ongoing Trials:

PARACHUTE IV

 Conclusion:

This device represents a percutaneous alternative for LV reduction surgeries. Long term safety and efficacy results to be seen.