PARACHUTE Left Ventricular Partitioning Device

Congestive heart failure is a serious disease which occurs when the heart is unable to pump sufficient blood to meet the body’s requirements. This results in symptoms such as breathlessness at rest or on activity, coughing, fatigue, ankle or abdominal swelling. It occurs in about 2% to 3% of the general population but increases to between 10% and 20% amongst the elderly population above the age of 70 years and is a frequent cause of hospitalization in this age group.

Patients with severe heart failure have a poor survival which is worse than some cancers such as prostate, bladder or uterine cancer. The commonest cause of heart failure is underlying coronary artery disease resulting in a heart attack which damages the heart muscle. As a result, the heart becomes enlarged and weak.

The current management of heart failure generally consists of medical, device or surgical therapy depending on the nature and severity of the heart failure and its underlying cause but medications remain the mainstay therapy. Recently, a novel therapy called the Parachute Ventricular Partitioning Device became available for use after undergoing clinical trials in Europe and USA. It is meant to help patients with heart failure as a consequence of a heart attack that has damaged the anterior or front surface of the heart causing the heart to enlarge and become aneurysmal or dilated at the apex or tip of the heart. Previously, the treatment of this condition requires major cardiac surgery but the outcomes have been variable and highly dependent on the surgical centers experience.

The Parachute Device provides an alternative option and is the first non-surgical solution for treating this problem. The procedure is performed by interventional cardiologists in a cath lab with an average procedure time of 2 hours. Patients are typically discharged 2 to 3 days following the procedure.
The Parachute Device ( Fig 1 ) has a metal frame made from nitinol that has been laser cut into 16 arms and is sandwiched between 2 layers of a polymer called PTFE and attached to a radiopaque foot. It is named as such because it looks like an inverted parachute. The device is folded and introduced through a plastic tube called a guiding catheter via a sheath in the femoral artery at the groin under local anesthesia and conscious sedation with X-ray guidance very similar to a coronary angiogram procedure. The guiding catheter is then positioned in the left ventricle which is the lower chamber of the heart that pumps blood to the rest of the body (Fig 2). The Parachute Device is than deployed in the left ventricle where it is expanded with balloon inflation to partition off the dilated or aneurysmal apex of the heart ( Fig 3 and 4 ) which will in turn restore the left ventricular size and function and enable it to pump blood more efficiently ( Fig 5 ). This will result in improvement of symptoms and functional status which was seen in a majority of patients who had received this device in the clinical trials.

IJN EXPERIENCE AND TRACK RECORD

The National Heart Institute in Kuala Lumpur was the first hospital in the Asia/Pacific region to implant this device into heart failure patients on 27th August 2013 and up to December 2013, we have successfully implanted a total of 6 patients with very satisfactory results. The future of this therapy appears promising. We hope to increase the number of procedures in the coming months for the benefit of patients who are deemed suitable for this type of therapy so as to enable them to enjoy an improvement in their quality of life.