Title
Successful Less-Invasive Ventricular Enhancement Treatment for Advanced Heart Failure
Introduction:
A 71-year-old female with a history of an anterior myocardial infarction 8 years previously and recent percutaneous coronary intervention (PCI) was referred for assessment of mitral regurgitation (MR) and progressive heart failure symptoms. An implantable cardioverter-defibrillator (ICD) was implanted, and she was not considered a suitable candidate for heart transplant or LVAD destination therapy. Echocardiogram showed moderate to severe septal hypertrophy, akinetic left ventricular (LV) apex, ejection fraction (EF) 20%–25%, and severely decreased LV systolic function. Mitral and tricuspid regurgitation (TR) were mild to moderate. Six-minute walk distance was 48 meters, with severe shortness of breath and fatigue. Catheterization showed LV end-systolic and end-diastolic volumes of 292 ml and 208 ml, respectively, with a calculated LVEF of 28.5%. The LV end-systolic volume index (LVESVI) was 118 ml/m2.
Clinical Case:
The patient underwent Less Invasive Ventricular Enhancement (LIVE) procedure for placement of the Revivent TC system (BioVentrix Inc., San Ramon, CA, USA) to reduce LV volume and exclude scarred area of the LV wall. A hinged anchor positioned in the right ventricle against the septum was connected to a locking anchor on the LV epicardium by a tether, then both anchors were drawn toward each other until contact between the two walls was established. Four anchor pairs were placed. The LV end-systolic and end-diastolic volumes decreased to 180 ml and 96 ml, respectively, and LVEF increased to 47%. The LVESVI decreased by 46% to 55 ml/m2. The patient was discharge 5 days after the procedure. At 6-month follow-up, the six-minute walk distance improved by 84% to 300 meters, LVEF was 48%, and the patient remained in NYHA class 1–2. At 1-year, the patient is very active with water aerobics and yoga, LVEF is 56%, and patient is NYHA class 1.
Discussion:
Case of a less invasive approach using the BioVentrix system to treat patients with an anterior scar and advanced heart failure as an alternative to surgical left ventricular reconstruction.