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Challenges in patient selection for the parachute device implantation
Author(s) -
BozdagTuran Ilkay,
Bermaoui Benjamin,
Paranskaya Liliya,
GökmenTuran R.,
D'Ancona Giuseppe,
Kische Stephan,
Birkemeyer Ralph,
Jovanovic Bojan,
Schuetz Jan,
Akin Ibrahim,
Turan Cem Hakan,
Ortak Jasmin,
Hauenstein K.,
Nienaber Cristoph Anton,
Ince Hueseyin
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24940
Subject(s) - medicine , ejection fraction , ventricle , myocardial infarction , cardiology , heart failure , prospective cohort study , ischemic cardiomyopathy , anterior wall , percutaneous
Background A novel percutaneous ventricular restoration therapy (PVRT) has been recently proposed to treat patients with ischemic heart failure (IHF) and antero‐apical regional wall motion abnormalities after myocardial infarction (MI). In this prospective, single center, non‐randomized study, we herein propose safety and feasibility evaluation of the device, in which a different patient selection strategy was used. Material and Methods A three‐stage evaluation was adopted in a series of patients referred for a Parachute Ventricular Partitioning Device (Parachute TM ). After an initial clinical evaluation, a secondary screening step was performed according to echocardiographic functional (LVEF<40%, apical/anterior akinesia/dyskinesia) and anatomical criteria [diameter of LV‐apex (LVAD) = 4.0 × 5.0 cm, left ventricular end diastolic diameter (LVEDD)>56 mm, left ventricular end systolic diameter (LVESD)>38 mm]. Patients encountering the echocardiographic criteria were selected for 3D cardiac CT (architecture, geometry, and trabeculation of the left ventricle) and eventually treated with the Parachute TM . Results Fifty patients were screened according to the echocardiographic criteria. Twenty‐seven of those that met the echo inclusion criteria underwent further cardiac CT imaging. After CT imaging, eight patients were scheduled for Parachute TM implantation. The device was successfully implanted in all eight patients with no in‐hospital mortality. A 3‐month follow‐up echocardiography showed LV‐volume reduction [95% CI; LVEDV: −76.5 (−116; −36.8), P = 0.002 and LVESV: −47.4 (−63.8; −30.9), P = 0.003] and improvement of global EF [95% CI; global EF: 6.87 (5.36; 8.39), P = 0.008]. Conclusion Selection criteria for Parachute TM placement should include left ventricular functional and anatomical parameters. When preprocedural echocardiography and cardiac CT are adequately implemented, satisfactory periprocedural and short term follow‐up results may be achieved after Parachute TM implantation. © 2013 Wiley Periodicals, Inc.