Five-Year Outcome of Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for the Treatment of Ischemic Heart Failure

Abstract

<h3>Purpose</h3> Remodelling of the left ventricle (LV) after anterior myocardial infarction (AMI) can result in a pathological increase in LV volume, reduction in LV ejection fraction (EF) and symptomatic heart failure (HF). We describe the five-year results of a hybrid transcatheter and minimally invasive surgical technique to reconstruct the remodelled LV by myocardial scar plication and exclusion. <h3>Methods</h3> Patients were eligible for the procedure when they presented with symptomatic HF (NYHA-class ≥II, EF<40%) after AMI. All patients had a dilated LV with a- or dyskinetic scar in the anteroseptal wall and/or apex ≥50% transmurality. Hybrid transcatheter and minimally technique (BioVentrix Revivent TC) that relies on micro-anchoring technology is used to reconstruct the LV by plication of the fibrous scar. A series of internal and external anchors are brought together over a PEEK (poly-ether-ether-ketone) tether to form a longitudinal line of apposition between the LV free wall and the anterior septum from the mid-ventricle to the apex. Internal anchors are deployed by transcatheter technique on the right side of the ventricular septum. External anchors are advanced through a left sided mini-thoracotomy and the anchor-pairs are brought together under measured compression forces. Additional external apical anchor pairs complete the reconstruction. <h3>Results</h3> Between October 2016 and October 2021 29 patients (24 males, 5 females; mean age 62 ± 12 years) were operated in a single Dutch centre. On average 2.3 ± 0.8 anchor-pairs were used for reconstruction. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 33 ± 8 to 44 ± 10% (change +35%, P<0.001) and LV-volumes decreased: LVESVI 56 ± 27 to 35 ± 19 ml/m² (change -36%, P<0.001) and LVEDVI 85 ± 33 to 59 ± 25 ml/m² (change -30%, P<0.001). Hospital mortality was 0%. and median length of hospital stay was 7 days (IQR 5-61 days). Survival at 60 months was 86%. At latest follow-up, 85% of surviving patients were in NYHA-class I-II compared to 19% preoperatively. <h3>Conclusion</h3> Hybrid transcatheter and minimally invasive LV reconstruction is a promising treatment option for patients with symptomatic HF after AMI. Five-year results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and sustained improvement in symptoms.