Authors:

J Naar¹ , I Skalsky² , F Malek¹ , K Van Bladel³ , L Annest³ , P Moucka¹ , A Kruger¹ , T Mraz¹ , P Neuzil¹ , ¹Na Homolce Hospital, Department of Cardiology - Prague - Czechia , ²Na Homolce Hospital, Cardiosurgery - Prague - Czechia , ³BioVentrix, Inc. - San Ramon - United States of America ,

Background

The evidence for surgical aneurysmectomy added to coronary artery bypass grafting procedure in patients with ischemic cardiomyopathy due to anterior myocardial infarction is ambiguous.

Purpose

The authors present 5-year results of hybrid minimally invasive left ventricular (LV) reconstruction performed as isolated procedure.

Methods

Heart failure patients with transmural post-infarction scar in left anterior descending (LAD) artery region were enrolled into the study. Main inclusion criteria were LV ejection fraction (EF) 15-45%, New York Heart Association (NYHA) class II-IV. Main exclusion criteria were LV trombus and myocardial infarction within 90 days prior enrollment. Scar tissue was excluded by Revivent TC system consisted of pairs of anchors implanted by internal jugular vein access from right side of interventricular septum (internal anchors) and left mini-thoracotomy (external anchors). Procedure was performed on beating heart. Transthoracic echocardiography, 6-minute walk test (6-MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ) and NT-proBNP level were evaluated pre-operatively and during subsequent follow-up visits.

Results

23 patients (15 males, mean age 59±11 years) were intervened between March 2014 and March 2019 in one heart center. System was successfully implanted in 22 subjects. On average, 2.8 anchor pairs were used for LV reconstruction. Mean operating time was 204±50 min. LV end-systolic volume index (LVESVI) was significantly reduced after 6 months (74.3±28 vs. 53.5±22 ml, p=0.02, n=18), 2 years (77.3±30 vs. 53.1±18 ml, p=0.02, n=14) as well as 5 years (72.4±11 vs. 54.5±11 ml, p=0.02, n=6). There was a trend towards LV EF increase. NYHA class ameliorated significantly throughout the follow-up (after 6 months 2.2±0.6 vs. 2.0±0.6, p=0.048, n=19; after 2 years 2.3±0.5 vs. 2.0±0.8, p=0.02, n=14; after 5 years 2.3±0.5 vs. 1.3±0.5, p=0.01, n=6), whereas 6-MWT, MLHFQ and NT-proBNP levels did not change.

Conclusion

Hybrid LV reconstruction with Revivent TC anchoring system is a feasible minimally invasive treatment method for selected patients with ischemic cardiomyopathy and transmural scar in LAD artery region, maintaining significant LVESVI reduction and NYHA class improvement during 5-year follow-up.