Parachute Device?

[bigdan]

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Hi guys -

I'm a 4th year medical student in the Greater NYC area, and I've recently heard radio ads recruiting for CHF pts for trials of a "parachute" device that might help improve quality of life.

I googled it and saw some images, but cannot figure out how this will help. Can anyone explain how the parachute works, and how it'll help? Does it just prevent dilated cardiomyopathy?

Thanks in advance for any explanations.

dc

 

[astropilot]

The whole idea is to decrease wall stress - that pressure that makes the ventricle balloon out. Now, we try to slow things (remodeling) down with mainly ACE-I. Think back to physiology. Remember Starling's Law (SV vs LVEDP). As the volume increases at the end of diastole, stroke volume decreases and snowballing as the ever-stretched myo-fibers can't contract well.

Surgeons thought they could fix things by reducing the ventricle size by, most recently, performing a partial left ventriculectomy (the Batista procedure - the Dor procedure was the forerunner). Initially, the procedure did work, but the longterm outcomes were dismal. Its no longer used regularly (STITCH trial with Blue Egg has continued).

Then the Accorn Cardiac Support device came along. Its basically a mesh that is wrapped around the heart to also decrease the size of the LV. Initial results are promising, but has not been finalized. There has also been the Myosplint that uses a few wires to bisect the LV by pulling the anterior/posterior walls together to make two chambers to thus decrease wall stress.

The parachutte works by reducing the LV volume by inserting a piece of material that walls off the distal and ballooning section of the LV thus decreasing the volume from within the LV. Its done percutaneously. The heart is still able to squeeze the blood out as the material is plyable, it just doesnt fill fully because of the wall.

Bottom line, these are for people who have failed the normal pharmaceuticals/pacing and who remain symptomatic. The idea is, reduce the LVEDP and improve symptoms.

Hope this helps.

 

[bigdan]

The whole idea is to decrease wall stress -

Hope this helps.

Indeed! Thanks a ton for all that info!

Best,

dc

 

[dragonfly99]

I would be quite nervous about increased clotting risk with any device that is INSIDE the ventricle. I personally wouldn't be the first to try this device if I had CHF...better to go with titrating up the ACE-I to the max, plus Coreg, and then try biventricular pacing....

 

[astropilot]

Absolutely agree, but these devices are used after maximum medical therapy and pacing have failed to improve symptoms. But, I've wondered about the clotting risk myself. It must be substantial.

 

[dragonfly99]

Are these used only after biventricular pacing has failed? That's much better/different than regular pacemakers are, usually.

 

[astropilot]

Are these used only after biventricular pacing has failed?

Yes, if the pt meets the requirements for bi_v pacing. That's what I was meaning when I used the term "pacing." (I should have been a bit more specific. Sorry.)