Background
Heart failure (HF) is an increasingly important source of morbidity and mortality in developed nations, and ischemic cardiomyopathy (ICM) is the most common cause.[1] Despite adequate treatment, with prompt percutaneous coronary intervention (PCI), up to 50% of patients lose 18% or more of left ventricular (LV) mass due to an acute myocardial infarction (MI).[2] Following primary PCI, guideline-directed medical therapy (GDMT) decreases the degree of LV remodelling, consequently reducing the development of ICM. Notwithstanding optimal GDMT after early reperfusion therapy, negative LV remodelling (defined as an increase of LV end-diastolic volume > 20% from baseline) has been observed in approximately one third of acute MI patients.[3] This increased LV volume is associated with major cardiac events, such as congestive HF, functional mitral regurgitation (FMR), apical aneurysm and risk of ventricular arrhythmia and sudden cardiac death. It is also related with decreased survival.[4]
In patients with a negatively remodeled LV, in whom the LV volume is increased, LV ejection fraction (EF) is depressed because of increased wall tension and less efficient myocardial fiber orientation and anterior myocardial scar tissue of at least 50% transmurality, surgical ventricular reconstruction (SVR) is an established therapy that can be considered. Its drawbacks are that this is a highly invasive open-heart surgical procedure performed with the use of extracorporeal circulation (ECC) and cardioplegic myocardial arrest.[5] Less Invasive Ventricular Enhancement (LIVE) technique with Revivent TCâ„¢ system (BioVentrix Inc., San Ramon, CA, USA) has been developed as an equally effective therapy to reconstruct the LV to decrease LV volume, reconstruct its physiologic shape and reduce LV wall tension. All this is aimed to improve LV performance leading to reduction of HF symptoms, increase quality of life and improve survival.[6]