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Review
. 2022 Aug 18;11(16):4831.
doi: 10.3390/jcm11164831.

State-of-the-Art Review: Technical and Imaging Considerations in Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for Ischemic Heart Failure

Romy Roosmarijn Maria Jacqueline Josepha Hegeman  1 , Martin John Swaans  2 , Jan-Peter van Kuijk  2 , Patrick Klein  1
Affiliations
Review

State-of-the-Art Review: Technical and Imaging Considerations in Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for Ischemic Heart Failure

Romy Roosmarijn Maria Jacqueline Josepha Hegeman et al. J Clin Med. .

Abstract

Negative left ventricular (LV) remodeling consequent to acute myocardial infarction (AMI) is characterized by an increase in LV volumes in the presence of a depressed LVEF. In order to restore the shape, size, and function of the LV, operative treatment options to achieve volume reduction and shape reconstruction should be considered. In the past decade, conventional surgical LV reconstruction through a full median sternotomy has evolved towards a hybrid transcatheter and less invasive LV reconstruction. In order to perform a safe and effective hybrid LV reconstruction, thorough knowledge of the technical considerations and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, a comprehensive understanding of the individual procedural steps from both a cardiological and surgical point of view is required.

Keywords: hybrid left ventricular reconstruction; ischemic cardiomyopathy; ischemic heart failure; left ventricular remodeling; minimally invasive cardiac surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of technical considerations based on scar distributions. Colored in red is the bail-out procedure in case the indicated hybrid endovascular approach is considered non-feasible because of increased procedural risk. Abbreviations: LV, left ventricle; RV, right ventricle.
Figure 2
Figure 2
LVOT area calculation based on the diameter of the LVOT. Abbreviations: LVOT, left ventricular outflow tract.
Figure 3
Figure 3
(A) CMR image showing a thrombus (asterisk) located in the apical left ventricular aneurysm in a patient with status after transmural infarction. Subendocardial late enhancement (arrow) is seen in the basal wall, lateral wall, and mid-portion of the septum. (B) CMR image showing transmural delayed enhancement extending from the basal to apical anteroseptal wall (arrow) in a patient with status after large transmural infarction of the anterolateral wall.
Figure 4
Figure 4
(A,B) Left anterior oblique (LAO) cranial coupes of CT-derived 3D reconstruction before LIVE procedure, made as part of procedural planning, revealing a prominent scarred aneurysm of the left ventricle (arrows).
See this image and copyright information in PMC

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