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.
– Interference of the device with papillary muscles or apical chordae tendineae is unknown
– Risks and consequences of dislocation.
– Thrombo-embolic risk.
This device represents a percutaneous alternative for LV reduction surgeries. Long term safety and efficacy results to be seen.