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The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles.

Publication ,  Journal Article
Costa, MA; Pencina, M; Nikolic, S; Engels, T; Templin, B; Abraham, WT
Published in: Am Heart J
April 2013

BACKGROUND: Left ventricle (LV) remodeling after anterior wall myocardial infarction leads to increased LV volumes, myocardial stress, and, ultimately, heart failure (HF). Patients have high morbidity and mortality risk, and treatment remains limited. Percutaneous ventricular restoration (PVR) therapy using the Parachute device, a fluoropolymer membrane stretched over a nitinol conical frame, is a novel approach to partition off the damaged myocardium. In the European and United States PARACHUTE feasibility trials, the observed rates of death or rehospitalization for HF were <17% at 12 months. These data compare favorably with historical data and support the need of a randomized trial to determine the clinical efficacy of PVR on outcomes for patients with ischemic HF. OBJECTIVE: To determine the safety and efficacy of PVR utilizing a LV partitioning device, Parachute, in a randomized clinical trial compared with optimal medical therapy. METHODS: This US pivotal trial is approved by the Food and Drug Administration (ClinicalTrials.gov Identifier: NCT01286116) and will randomly assign (1:1) 478 patients with New York Heart Association class III-IV ischemic HF, akinetic or dyskinetic LV wall abnormality, and ejection fraction between 15% and 35% to optimal medical therapy (control) versus Parachute device implantation in approximately 65 hospitals. The primary endpoint is death or rehospitalization for worsening HF. Sample size calculation assumes constant hazards and follow-up ≥12 months using an event-driven trial design. CONCLUSIONS: We reported the rational and design of the first multicenter randomized trial to test the efficacy of PVR using the Parachute device to treat patients with ischemic HF and dilated LV.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2013

Volume

165

Issue

4

Start / End Page

531 / 536

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Research Design
  • Randomized Controlled Trials as Topic
  • Prosthesis Implantation
  • Prosthesis Design
  • Prostheses and Implants
  • Polytetrafluoroethylene
  • Patient Selection
  • Myocardial Ischemia
 

Citation

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Costa, M. A., Pencina, M., Nikolic, S., Engels, T., Templin, B., & Abraham, W. T. (2013). The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles. Am Heart J, 165(4), 531–536. https://doi.org/10.1016/j.ahj.2012.12.022
Costa, Marco A., Michael Pencina, Serjan Nikolic, Thomas Engels, Barry Templin, and William T. Abraham. “The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles.Am Heart J 165, no. 4 (April 2013): 531–36. https://doi.org/10.1016/j.ahj.2012.12.022.
Costa, Marco A., et al. “The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles.Am Heart J, vol. 165, no. 4, Apr. 2013, pp. 531–36. Pubmed, doi:10.1016/j.ahj.2012.12.022.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2013

Volume

165

Issue

4

Start / End Page

531 / 536

Location

United States

Related Subject Headings

  • Ventricular Remodeling
  • Ventricular Dysfunction, Left
  • Research Design
  • Randomized Controlled Trials as Topic
  • Prosthesis Implantation
  • Prosthesis Design
  • Prostheses and Implants
  • Polytetrafluoroethylene
  • Patient Selection
  • Myocardial Ischemia