Live Procedure And Revivent Myocardial Anchoring System A New Heart Team Approach In Treatment Of Heart Failure Patients
Nicolai C. Bayer, Christian Frerker, Michael Schmoeckel, Ralf Bader.
AK St. Georg, Hamburg, Germany.
OBJECTIVE: Left ventricular (LV) dilatation in ischemic cardiomyopathy results in severe disturbance of the mechanics of ventricular contraction. Less Invasive Ventricular Enhancement™ (LIVE™) using the Revivent TC™ Myocardial Anchoring System (BioVentrix Inc., San Ramon, CA, USA) is a new therapeutic option for heart failure patients with myocardial infarction and marked anteroseptal or apical scars to reduce LV volumes without the need of a sternotomy or cardiac arrest.
METHODS: We report a case of a 77-year-old male patient with ischemic cardiomyopathy and severely impaired LV function. The patient has a history of multiple myocardial infarctions with consecutive coronary interventions and a remaining anteroseptal aneurysm. LV restoration was performed in hybrid OR under transesophageal echocardiography and fluoroscopy guiding. A left sided 6 cm anterolateral minithoracotomy was chosen as surgical access while venous catheters were introduced via the right jugular vein. The surgeon punctured the LV free wall at the edge of the aneurysm with a specialized curved needle and continued through the interventricular septum into the right ventricle (RV). Through this needle a guidewire is passed into the RV. The guide wire was caught with a snare and pulled back via the jugular venous port where the internal anchor was assembled externally. With the internal anchor at the interventricular septum, the external anchor could be advanced until the scar was excluded in the myocardial plication
RESULTS: In total 4 anchors were successfully placed and showed an immediate reduction of LV volume by excluding the aneurysm. (pre: enddiastolic volume (EDV) 593 ml, end systolic volume (ESV) 545 ml stroke volume (SV) 48 ml; post: EDV 442, ESV 377 ml, SV 65 ml)
CONCLUSIONS: The LIVE™ Procedure and Revivent™ Myocardial Anchoring System is a promising new therapeutic approach for heart failure patients with anteroseptal scars. Given the large number of frail patients suffering from ischemic cardiomyopathy less invasive therapeutic strategies are indispensable. We demonstrated this technique to be a safe procedure, but further investigation and larger numbers of patients are necessary to evaluate the long term clinical effects.
Back to 2017 Display Posters