Article Abstract

Less invasive ventricular enhancement (LIVE) as potential therapy for ischaemic cardiomyopathy end-stage heart failure

Authors: Antonio Loforte, Jacopo Alfonsi, Gregorio Gliozzi, Gianluca Folesani, Mariafrancesca Fiorentino, Mauro Biffi, Giuseppe Marinelli, Roberto Di Bartolomeo, Davide Pacini

Abstract

Background: Surgical ventricular reshaping (SVR) is a treatment option for patients with severe ischaemic heart failure (HF). Recently, a new minimally invasive, hybrid technique named “less invasive ventricular enhancement” (LIVE), has been developed adopting the Reviven™ Myocardial Anchoring System (BioVentrix Inc., San Ramon, CA, USA).
Methods: Between January 2015 and November 2018, 7 patients (5 men and 2 women; mean age 72±8.9 years) underwent LIVE procedure at our institution.
Results: Procedural success was 100%. A total anchors number of 3.0±0.9 was used to reshape the left ventricle (LV). Preoperative and postoperative echocardiographic assessments showed an increase of LV ejection fraction (EF) from 22.8%±8.1% to 35%±7.2% (P=0.001) and a decrease of LV volumes in terms of LV end-systolic volume index (LVESVI), from 93.2±10.5 to 52.1±15.1 mL/m2 (P<0.001), and LV enddiastolic volume index LVEDVI, from 137.2±20.1 to 78±10.2 mL/m2 (P=0.001), respectively. In all patients functional mitral regurgitation (MR) prior to surgery decreased significantly after LIVE procedure. In 1 patient, the occurrence of right ventricle perforation required correction through a standard sternotomy. All patients survived the surgical procedure. The mean duration of intensive care unit stay was 7.8 days (range, 1–22 days), and the mean length of hospital stay was 22.1 days (range, 9–45 days). Mean follow-up (FU) time was 189.7±104.5 days. Average NYHA functional class at FU was 1.4±0.9 compared to 3.4±0.6 preoperatively (P=0.001). All patients were in satisfactory clinical condition and resumed their own daily activities. Echocardiographic monitorings at FU were stable and comparable to the above mentioned results at discharge.
Conclusions: In high-risk patients and selected cases, LIVE procedure may be advantageous both technically and clinically. Preliminary results of this novel hybrid treatment for symptomatic ischaemic cardiomyopathy are encouraging, in terms of significant improvement in LV EF, reduction in LV volumes and functional MR grade.