Tag Archives: percutaneous intervention

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.

Renal artery denervation in post-stenting patients

RENAL ARTERY DENERVATION FOR HYPERTENSION REFRACTORY TO STENTING

A new study published in Journal of endovascular therapy (2014;21:181–190) has evaluated the efficacy of renal denervation therapy for hypertension refractory to renal artery stenting.

The study included ten patients (6 women; mean age 70.0±5.1 years) with an office systolic blood pressure >160 mmHg despite taking ≥3 antihypertensive drugs and uni- or bilateral renal artery stenting. These patients were treated with RDN. Radiofrequency (RF) energy was delivered to the native segment of the artery keeping a 5-mm safe distance from the stented segments. Standardized office and ambulatory blood pressure measurements, medication, and renal assessment, including renal duplex ultrasound and renal function, were determined at baseline and on follow-up to 12 months.

 

Office BP  (systolic/diastolic) at baseline was 190.0±20.4 / 84.2±10.1 mmHg. It decreased to 171.1±28.7 / 82.2±8.7, 165.5±28.4 / 76.1±7.4, and 158.3±14.2/ 75.5±9.5 mmHg (p<0.01) at 3, 6, and 12 months after RDN, respectively. Average ambulatory BP (systolic/diastolic) after 6 and 12 months decreased by −7.6/ −3.1 and −11.3 / −5.1 mmHg (p<0.05).

There was no renal artery (re)stenosis, dissection, or aneurysm within 12 months.

Creatinine, cystatin C, and glomerular filtration rate remained unchanged.

Urine albumin excretion decreased in 4/10 patients.

Renal resistive indices improved in native, but not in stented renal arteries within the follow-up period.

RF-based RDN can be safely and effectively delivered in patients with resistant hypertension and previous renal artery stenting.”