Less invasive ventricular reconstruction for ischaemic heart failure

Abstract

AimsSurgical ventricular reconstruction to remodel, reshape, and reduce ventricular volume is an effective therapy in selected patients with chronic heart failure (HF) of ischaemic aetiology. The BioVentrix Revivent TC System offers efficacy comparable to conventional surgical ventricular reconstruction and is less invasive utilizing micro‐anchor pairs to exclude scarred myocardium on the beating heart. Here, we present 12‐months follow‐up data of an international multicenter study.Methods and resultsPatients were considered eligible for the procedure when they presented with symptomatic HF [New York Heart Association (NYHA) class ≥II], left ventricular (LV) dilatation and dysfunction caused by myocardial infarction, and akinetic and/or dyskinetic transmural scarred myocardium located in the anteroseptal, anterolateral, and/or apical regions. A total of 89 patients were enrolled and 86 patients were successfully treated (97%). At 12 months, a significant improvement in LV ejection fraction (29 ± 8% vs. 34 ± 9%, P < 0.005) and a reduction of LV volumes was observed (LV end‐systolic and end‐diastolic volume index both decreased: 74 ± 28 mL/m2 vs. 54 ± 23 mL/m2, P < 0.001; and 106 ± 33 mL/m2 vs. 80 ± 26 mL/m2, respectively, P < 0.0001). Four patients (4.5%) died in hospital and survival at 12 months was 90.6%. At baseline, 59% of HF patients were in NYHA class III compared with 22% at 12‐month follow‐up. Improvements in quality of life measures (Minnesota Living with Heart Failure Questionnaire 39 vs. 26 points, P < 0.001) and 6‐min walking test distance (363 m vs. 416 m, P = <0.001) were also significant.ConclusionsTreatment with the Revivent TC System in patients with symptomatic HF results in significant and sustained reduction of LV volumes and improvement of LV function, symptoms, and quality of life.

Left ventricular surgical remodeling 2.0

“…In this issue, Pillay et al 9 describe a modification of a hybrid technique by them previously used, 10 In this study, 9 this technique was changed (and very likely improved) starting July 2018. The clinical results were very good: 47 cases reported (till January 2020), no in-hospital deaths, no complications, no late mortality, and clinical results reported an improvement of 1 New York Heart Association class after a mean follow-up of 9.8 months.…”

“…In this issue, Pillay et al 9 describe a modification of a hybrid technique by them previously used, 10 that allows interventional cardiologists and cardiac surgeons to work together to reduce the LV volume after an anterior myocardial infarction. A series of internal (right ventricular septum) and external (anterior wall) anchors are implanted to approximate the LV free wall to the anterior septum, consequently excluding the scarred myocardium.…”

“…The Authors do not compare the clinical outcome of the different hybrid techniques by them used. Their most recent clinical study 10 reports the results of the first version of hybrid technique ( n = 35) which replaced the median sternotomy. Some mechanical complications, as tricuspid insufficiency increase and ventricular septal defect, were reported and very likely pushed to introduce some modifications.…”

‘Off‐pump’ left ventricular reconstruction – A causal and less invasive surgical option for patients with advanced systolic heart failure?

“…In a recent issue of the Journal, Klein et al . demonstrate the effectiveness of the BioVentrix Revivent TC System using two approaches, either by median sternotomy or hybrid transcatheter and mini‐thoracotomy technique, in 86 patients.…”

“…The key question regarding SVR consists in the optimal time point for performing SVR in each individual HF patient. Furthermore, the identification of those patients that benefit most from SVR remains difficult . In this context, the findings by Klein et al .…”