LIVE Procedure - A Bespoke Technique for Ischemic Heart Failure

Abstract

<h3>Purpose</h3> Ischemic cardiomyopathy is the most common cause of heart failure (HF). In patients with left ventricular (LV) dilatation, low ejection fraction (EF) and transmural scar, Less Invasive Ventricular Enhancement (LIVE procedure) is a therapeutic option. LIVE is a unique minimal invasive intervention to exclude scarred myocardium, reduce volumes and reshape the LV, while improving HF symptoms. The procedure can be tailored to the unique characteristics of individual scar morphology. <h3>Methods</h3> We herein report 2 cases that highlight this therapy's scope of applicability. <h3>Results</h3> First patient is a 69 year-old male with a mid anterior wall and apical myocardial infarct (MI), which resulted in a dyskinetic scar. Despite guideline-directed medial therapy (GDMT), he was in NYHA class III. Cardiac CT showed a dilated heart with a LV end-systolic volume index (LVESVI) of 82 mL/m² and an EF of 24%. Due to recurrent ventricular tachycardia (VT), he underwent endocardial ablation. However, persistent slow VT's were shown during follow-up. As such, he underwent successful LIVE procedure using 3 Revivent TC™ (BioVentrix™) surgically applied anchors combined with epicardial cryoablation using the Atricure™ CryoICE™, improving his LVESVI to 52 mL/m² (-37%) and EF to 33% (+38%). Post-operative (PO) course was uneventful and follow-up defibrillator interrogation showed no sign of VT's. NYHA class improved to class I. Second patient is a 62 year-old male who suffered a previous osteal left anterior descending artery MI. This has resulted in extreme LV remodeling, with a LVESVI of 162 mL/m2 and EF of 18% by CT, due to a large highly transmural scar. Despite GDMT, he was in NYHA III. As there was an important septal scar component, he underwent hybrid LIVE procedure with Revivent TC™ system (RV-LV). 5 anchor pairs were used, including 1 internal anchor, 1 Antonius stitch (external RV-LV) and 3 LV-LV anchor pairs. PO course was straightforward and he was discharged on PO day #6. Follow-up CT showed a LVESVI of 60 mL/m2 (-63%), an EF of 44% (+151%) and full scar exclusion. <h3>Conclusion</h3> Hybrid LV reshaping and volume reduction is a safe and effective option in patients with symptomatic HF after MI. The procedure is highly customizable and adaptable to each patient's scar morphology. Additionally, concomitant procedures are possible, as described above, making of this therapy a valuable tool in the HF therapeutic armamentarium.