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

Background: Left 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.Methods: Ten 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.Results: Parachute 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 v; 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 a 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-¦0.27mmHg/mL to 1.37-¦0.52 mmHg/mL, P<0.05)).Conclusion: This 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