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]