Long-Term Results of Hybrid Left Ventricular Reconstruction in the Treatment of Ischemic Cardiomyopathy

Abstract

The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15-45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure.

Keywords: Hybrid approach; Ischemic cardiomyopathy; Left ventricular aneurysm; Left ventricular reconstruction.

Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure.

Fig. 1

Change in LVESVI at 6 months, 2 years, and 5 years. Data are expressed as mean ± standard deviation. *p = ns, †p = ns, ‡p = ns. LVESVI, left ventricular end-systolic volume index

Fig. 2

Individual changes in LVESVI at 6 months, 2 years, and 5 years. LVESVI, left ventricular end-systolic volume index

Fig. 3

Change in left ventricular ejection fraction (a) and mitral regurgitation (b) at 6 months, 2 years, and 5 years. Data are expressed as mean ± standard deviation. *p = ns, †p = ns, ‡p = ns. LV, left ventricle; EF, ejection fraction

Fig. 4

Effect on clinical parameters relevant to HF and NT-proBNP at 6 months, 2 years, and 5 years. Data are expressed as mean ± standard deviation. *p = ns, †p = ns, ‡p = ns. MLHFQ, Minnesota Living with Heart Failure Questionnaire; NT-proBNP, N-terminal prohormone of brain natriuretic peptide; NYHA, New York Heart Association; 6-MWT, 6-min walk test

Fig. 5

Effect of baseline LVESVI on clinical parameters at 2 and 5 years. Subgroup analysis based on preoperative LVESVI (cut-off 70 ml/m²) showing the effect of index procedure on NYHA (a, d), 6-MWT (b, e), and MLHFQ (c, f) at 2 and 5 years compared to baseline. Data are expressed as mean ± standard deviation of the change. *p = ns, †p = ns, ‡p = ns. BL, baseline; LVESVI, left ventricular end-systolic volume index; MLHFQ, Minnesota Living with Herat Failure Questionnaire; NYHA, New York Heart Association; 6-MWT, 6-min walk test