title: The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles.
abstract: 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.
authors.affiliation: University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Costa
authors.forename: Michael
authors.initials: M
authors.lastname: Pencina
authors.forename: Serjan
authors.initials: S
authors.lastname: Nikolic
authors.forename: Thomas
authors.initials: T
authors.lastname: Engels
authors.forename: Barry
authors.initials: B
authors.lastname: Templin
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000628:therapy; D017202:Myocardial Ischemia / Q000601:surgery; D018579:Patient Selection; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000628:therapy*; D020257:Ventricular Remodeling / Q000502:physiology*
chemical_list: D011138:Polytetrafluoroethylene