prospective evaluation of elastic restraint to lessen the effects of heart failure (peerless-hf) trial

Conditions: Heart Failure

Summary: the purpose of this study is to determine if patients in the heartnet ventricular support system with optimal medical and device therapy arm (treatment group) show statistically significant improvement compared to patients in the optimal medical and device therapy alone arm (control group) after 6 months of follow-up.

in the united states alone, more than five million people suffer from heart failure (chf) and an estimated 400,000 to 700,000 new cases are diagnosed each year. caused by a variety of cardiac conditions, systolic heart failire (hf) is the end-stage of heart disease where the heart is failing as a pump. once diagnosed with the disease, less than 50% of the patients live for five years, and less than 25% survive for more than ten years. the number of deaths in the united states from this condition has more than doubled since 1979, averaging more than 250,000 annually. paracor medical, inc. has developed an elastic prosthetic wrap that is designed to apply a gentle mechanical support to the failing heart. the implant is a compliant elastic structure that is designed to conform to the epicardial surface of the right and left ventricles. it supports the heart throughout the cardiac cycle and was designed to offload the ventricles and reduce wall stress. the objective of this clinical trial is to evaluate the safety and efficacy of the heartnet ventricular support system with optimal medical and device therapy (treatment group) when compared to optimal medical and device therapy (i.e., medications, cardiac resynchronisation therapy, pacemaker) alone (control group) as treatments for patients with heart failure. efficacy of the heartnet ventricular support system in the treatment group compared to the optimal medical and device therapy control group will be evaluated based upon cardiopulmonary tests (peak vo2), six (6) minute walk distance and quality of life assessment, as measured by the minnesota living with heart failure (mlwhf) questionnaire. safety of the heartnet ventricular support system in the treatment group compared to the control group will be evaluated based on the all-cause mortality rate. paracor medical intends to submit data obtained in this clinical trial to support a pre-market approval application to the united states food and drug administration.

Eligibility criteria:
inclusion criteria: 1. symptomatic heart failure at enrollment (american college of cardiology \[acc\]/american heart association \[aha\] stage c) due to ischemic or nonischemic dilated cardiomyopathy 2. on stable, evidence-based medical and device therapy for heart failure for 3 months prior to randomization \ pharmacological therapy (as appropriate) \ angiotensin converting enzyme (ace) inhibitors or angiotensin ii receptor blockers (arb) for patients with ace inhibitor intolerance or nitrate/hydralazine at the investigators discretion \ beta blockers \ diuretics, aldosterone inhibitors \ ejection fraction \ cardiac resynchronization therapy (crt), cardiac resynchronization therapy-defibrillator (crt-d) \ if implanted with a crt or crt-d, it must be implanted \> or = to 3 months before randomization \ if currently eligible or anticipated eligibility with a crt or crt-d within 6 months, the patient should not be enrolled in the study specific qualifying characteristics 1. six (6) minute walk of 150 - 450m 2. peak vo2 for males: 10.0-20.0 ml/kg/min; peak vo2 for females: 9.0-18.0 ml/kg/min 3. left ventricular end diastolic diameter (lvedd) \<85mm and index \<40mm/m2 (lvedd/bsa) 4. heart failure duration \> or = to 6 months exclusion criteria: patient history 1. heart failure due to a reversible condition 2. hypertrophic obstructive cardiomyopathy (hocm) 3. left ventricular assist device (lvad), intra-aortic balloon pump (iabp) or intravenous inotropes are required or the patient has end stage heart failure despite maintenance on best medical therapy 4. myxoma 5. active infection, sepsis, endocarditis, myocarditis or pericarditis 6. myocardial infarction, stroke, transient ischemic attack, cardiac or other major surgery, or implantable cardioverter defibrillator (icd) or pacemaker implantation in the 3 months prior to entry 7. positive pregnancy test for pre-menopausal female 8. less than 18 years or \> or = to 75 years old 9. hemoglobin level less than 10 gm/dl or creatinine \>2.5 mg/dl 10. uncontrolled medical conditions that increase surgical risk 11. co-morbid condition that in the investigator's opinion reduces life expectancy to less than 2 years surgical or anatomical considerations 1. heart measurement too large or small for implant sizes 2. restrictive cardiomyopathy 3. not a candidate for sternotomy or standard thoracotomy surgical approaches 4. expected to have adhesions from previous surgical procedures 5. history of constrictive pericarditis 6. previously placed coronary artery bypass grafts (cabg) or anticipated need for coronary artery bypass grafting 7. not a candidate for cardiopulmonary bypass 8. anatomical mitral valve regurgitation of 2+ or greater at the time of enrollment 9. pulmonary function testing with the following results: forced expiratory volume (fev1) \<1l or if fev1 is between 1 and 3l, forced expiratory volume divided by forced vital capacity (fev1/fvc) \<60% 10. cardiac or thoracic condition that might require operative correction. cardiac transplantation is not included in this exclusion criterion. 11. other elective surgical procedure at the time of the index hospitalization or within 30 days, whichever is longer other 1. any other medical condition that, in the judgment of the investigator, makes the patient a poor candidate for this procedure 2. currently enrolled or has participated in the last 30 days in another therapeutic or interventional clinical study 3. unwilling/unable to comply with follow-up 4. unwilling/unable to give signed informed consent

Keywords: heart failure cardiac support paracor heartnet peerless-hf