Novel Devices for Advanced HF on Horizon

MIAMI BEACH, FLA.—During a presentation at TCT 2012, Daniel Burkhoff, MD, PhD, from Columbia University in New York, discussed novel device-based therapies for the treatment of advanced heart failure.

The PARACHUTE device (CardioKinetics), for example, is a percutaneous ventricular restoration device which features nitinol struts with anchors and a radiopaque polymer foot. In patients with anterior infarct, the device is placed in the area where it will exclude or partition the apical region and weave the contracting part of the muscle to operate without the energetic inefficiency of contracting against the diskinetic apex, Burkhoff said.

Another device, the Inter-Atrial Shunt Device (DC Devices) has entered in first-in-man studies outside of the US for HF with preserved ejection fraction. In patients with HF with preserved ejection fraction, the intracardiac device creates a well-controlled shunt between the right and left atria. The intended result is a decompressed left atrium, improved exercise capacity and QOL. 

Mechanical circulatory support systems also have evolved, Burkhoff said, and are now smaller in size with reduced invasiveness (see Figure). One such device, the Synergy Circulatory Assistance Device (CircuLite), is nearing first-in-man trials in Europe. Despite current ventricular assist devices designed to provide full support for treatment of these patients at the end-stage of their disease, there are still patients with somewhat lesser degrees of compromise who are unable to maintain significant quality of life, he said.

“As heart disease progresses, the frequency of hospitalizations in this patient population increase, sometimes requiring inotropic support and sometimes slipping into states of inotrope dependence,” said Burkhoff. He added that there is still a huge unmet need for devices in HF patients, especially in those who are class 3 to 4 and those with cardiogenic shock. “We have a lot of options [still] being investigated,” he said.