Transcatheter Structural Heart Interventions for the Treatment of Chronic Heart Failure.

Abstract

Heart failure (HF) is a major cause of mortality and morbidity in developed countries.1 In the past 2 decades, improvements in drug therapy and the widespread use of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices has improved the prognosis of HF patients.2 However, morbidity and mortality rates remain high, with an estimated 5-year mortality rate exceeding 50% coupled with significant rehospitalization rates. Several transcatheter implantable devices have recently emerged in an attempt to improve the prognosis and quality of life of such patients. We reviewed the current literature on interventional chronic HF. The review focus on the description of the devices and main procedural characteristics, patient eligibility, procedural results, and clinical outcomes associated with such devices. This article will focus only on mechanical transcatheter structural heart interventions for treating chronic HF. Devices used for percutaneously delivering biological therapies and interventions for acute HF fall beyond the scope of this article. Several surgical and device-based therapies have emerged in an attempt to reverse LV remodeling by restoring normal LV architecture and reducing LV volumes and wall stress. Among these surgical therapies, the most commonly used is the endoventricular circular patch plasty or Dor procedure, which consists of excluding the akinetic septal and apical ventricular regions by performing aneurysm resection with the insertion of a circular pericardial patch. Although this procedure showed promising results in multicenter registries,3 the only randomized trial—Surgical Treatment for Ischemic Heart Failure (STICH)—failed to demonstrate differences in the composite end point of death and rehospitalization for cardiac causes between surgical ventricular restoration+coronary artery bypass graft versus coronary artery bypass graft alone.4 However, some subgroups, experienced significant benefits with surgical ventricular restoration.5,6 In this regard, the parachute device (Cardiokinetix, Inc, Menlo Park, CA) emerged as a percutaneous device with the purpose of …