Percutaneous Ventricular Restoration Using the Parachute Device: The Parachute III Pressure-Volume Loop Sub-study

BackgroundLeft ventricular (LV) dilatation and remodeling following acute myocardial infarction increases wall stress, ventricular volumes and leads to heart failure (HF), which is associated with a high mortality. Percutaneous ventricular restoration (pVR) therapy reduces LV volumes leading to a more effective ejection. This study investigated the hemodynamic effects of LV volume reduction from pVR on LV performance and its interaction with the arterial system.MethodsTen patients with symptomatic ischemic HF of New York Heart Association (NYHA) classes II to IV with LV antero-apical wall motion abnormalities underwent Parachute implantation. Pressure-volume loops were recorded immediately pre- and post-pVR implantation and at 6-month follow up.ResultsParachute implantation significantly reduced end-diastolic volume index (from 112 ± 39 mL to 100 ± 41 mL; p < 0.05), with a greater relative reduction in end-systolic volume index (from 66 ± 33 mL to 56 ± 32 mL; p < 0.05) with an overall 7% increase in ejection fraction (from 38 ± 11 to 46 ± 14%; p < 0.05). Furthermore, there was an observed reduction in dyssynchrony index (from 20 ± 4 to 14 ± 6%; p < 0.05) and enhanced contractile function (Ees) immediately post-procedure, sustained at 6-months (from 0.92 ± 0.27 mmHg/mL to 1.37 ± 0.52 mmHg/mL, p < 0.05).ConclusionThis present study confirms positive hemodynamic effects of LV volume reduction using the Parachute percutaneous ventricular restoration device. The Parachute device improved synchronous contraction and enhanced ventricular-arterial interaction likely due to LV reverse remodeling.