Heart Failure Interventions Targeting Impaired Left Ventricles in Structural Heart Disease
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Purpose of Review
Interventional techniques have been developed for a wide spectrum of mechanisms of heart failure (HF), especially in valvular heart disease and cardiomyopathies (ischaemic cardiomyopathy and hypertrophic cardiomyopathy). In this article, we review recent reports on catheter interventions to treat patients with HF.
Direct modification using the Parachute device and the REVIVENT-TC device for patients with impaired left ventricle with large infarct scars improves geometry and haemodynamic efficiency, resulting in a reduction of HF symptoms. Interatrial shunt therapy improves symptoms and quality of life in HF patients. Uniquely, left ventricular outflow tract obstruction has also been targeted in patients with transcatheter mitral valve implantation.
For advanced stage HF patients with prohibitively high surgical risk, emerging transcatheter interventions make it possible to modify life-limiting symptoms. Further results on HF interventions are expected from ongoing clinical trials.
KeywordsHeart failure interventions Ischaemic cardiomyopathy Left ventricular reconstruction Interatrial shunt device Left ventricular outflow tract obstruction
Compliance with Ethical Standards
Conflict of Interest
Mitsunobu Kitamura, Karl-Heinz Kuck, and Christian Frerker declare that they have no conflict of interest. Tobias Schmidt receives lecture honoraria from CardioKinetix and Bioventrix.
Human and Animal Rights and Informed Consent
This article is a review and contains studies of humans in which we participated. These were the PARACHUTE III and V, the Bioventrix studies and the Mitraclip procedure in HOCM patients. All patients signed a patient informed consent form.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Bolognese L, Neskovic AN, Parodi G, Cerisano G, Buonamici P, Santoro GM, et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation. 2002;106(18):2351–7. https://doi.org/10.1161/01.CIR.0000036014.90197.FA.CrossRefPubMedGoogle Scholar
- 2.Savoye C, Equine O, Tricot O, Nugue O, Segrestin B, Sautiere K, et al. Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group). Am J Cardiol. 2006;98(9):1144–9. https://doi.org/10.1016/j.amjcard.2006.06.011.CrossRefPubMedGoogle Scholar
- 3.•• Costa MA, Mazzaferri EL Jr, Sievert H, Abraham WT. Percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure: three-year outcomes of the PARACHUTE first-in-human study. Circ Heart Fail. 2014;7(5):752–8. This is the first human study of a parachute device. CrossRefPubMedGoogle Scholar
- 4.•• Thomas M, Nienaber CA, Ince H, Erglis A, Vukcevic V, Schafer U, et al. Percutaneous ventricular restoration (PVR) therapy using the parachute device in 100 subjects with ischaemic dilated heart failure: one-year primary endpoint results of PARACHUTE III, a European trial. EuroIntervention. 2015;11(6):710–7. This report provides the results from the largest multicenter study of parachute device. CrossRefPubMedGoogle Scholar
- 5.Del Trigo M, Bergeron S, Bernier M, Amat-Santos IJ, Puri R, Campelo-Parada F, et al. Unidirectional left-to-right interatrial shunting for treatment of patients with heart failure with reduced ejection fraction: a safety and proof-of-principle cohort study. Lancet. 2016;387(10025):1290–7. https://doi.org/10.1016/S0140-6736(16)00585-7.CrossRefPubMedGoogle Scholar
- 6.• Schmidt T, Frerker C, Thielsen T, Dotz I, Wohlmuth P, Kuck KH, et al. New evidence for favourable effects on haemodynamics and ventricular performance after parachute((R)) implantation in humans. Eur J Heart Fail. 2014;16(10):1112–9. This study descrives the effects of parachute device implantation on haemodynamics. CrossRefPubMedGoogle Scholar
- 8.Costa MA, Pencina M, Nikolic S, Engels T, Templin B, Abraham WT. The PARACHUTE IV trial design and rationale: percutaneous ventricular restoration using the parachute device in patients with ischemic heart failure and dilated left ventricles. Am Heart J. 2013;165(4):531–6. https://doi.org/10.1016/j.ahj.2012.12.022.CrossRefPubMedGoogle Scholar
- 9.Cooley DA. Ventricular endoaneurysmorrhaphy: a simplified repair for extensive postinfarction aneurysm. J Card Surg. 1989;4(3):200–5. https://doi.org/10.1111/j.1540-8191.1989.tb00282.x.CrossRefPubMedGoogle Scholar
- 11.Athanasuleas CL, Stanley AW Jr, Buckberg GD, Dor V, DiDonato M, Blackstone EH. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group Reconstructive Endoventricular Surgery, returning Torsion Original Radius Elliptical Shape to the LV. J Am Coll Cardiol. 2001;37(5):1199–209.CrossRefPubMedGoogle Scholar
- 15.Michler RE, Rouleau JL, Al-Khalidi HR, Bonow RO, Pellikka PA, Pohost GM, et al. Insights from the STICH trial: change in left ventricular size after coronary artery bypass grafting with and without surgical ventricular reconstruction. J Thorac Cardiovasc Surg. 2013;146(5):1139–45 e6. https://doi.org/10.1016/j.jtcvs.2012.09.007.CrossRefPubMedGoogle Scholar
- 17.•• Wechsler AS, Sadowski J, Kapelak B, Bartus K, Kalinauskas G, Rucinskas K, et al. Durability of epicardial ventricular restoration without ventriculotomy. Eur J Cardiothorac Surg. 2013;44(3):e189–92. https://doi.org/10.1093/ejcts/ezt292. discussion e92. This is the first report of epicardial ventricular restoration using the Revivent device. CrossRefPubMedGoogle Scholar
- 18.Heeger CH, Frerker C, Hayashi K, Schmidt T, Mathew S, Sohns C, et al. Catheter ablation of frequent ventricular tachycardia after interventional left ventricular restoration with the revivent-transcatheter(TM)-system. Clin Case Rep. 2016;4(4):339–43. https://doi.org/10.1002/ccr3.512.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Observational study to collect data on health improvements after mini-invasive operation with Revivent TC device to reshape the heart and reduce its volume: BioVentrix Registry Assessment of Ventricular Enhancement for the Revivent TC system (BRAVE-TC). https://doi.org/10.1186/ISRCTN89757315, 2016; URL http://www.isrctn.com/ISRCTN89757315.
- 20.Sondergaard L, Reddy V, Kaye D, Malek F, Walton A, Mates M, et al. Transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel interatrial implant to lower left atrial pressure. Eur J Heart Fail. 2014;16(7):796–801. https://doi.org/10.1002/ejhf.111.CrossRefPubMedGoogle Scholar
- 21.Malek F, Neuzil P, Gustafsson F, Kaye DM, Walton A, Mates M, et al. Clinical outcome of transcatheter treatment of heart failure with preserved or mildly reduced ejection fraction using a novel implant. Int J Cardiol. 2015;187:227–8. https://doi.org/10.1016/j.ijcard.2015.03.198.CrossRefPubMedGoogle Scholar
- 22.Feldman T, Komtebedde J, Burkhoff D, Massaro J, Maurer MS, Leon MB, et al. Transcatheter interatrial shunt device for the treatment of heart failure: rationale and design of the randomized trial to REDUCE elevated left atrial pressure in heart failure (REDUCE LAP-HF I). Circ Heart Fail. 2016;9(7):e003025. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003025.CrossRefPubMedGoogle Scholar
- 23.Hasenfuss G, Hayward C, Burkhoff D, Silvestry FE, McKenzie S, Gustafsson F, et al. A transcatheter intracardiac shunt device for heart failure with preserved ejection fraction (REDUCE LAP-HF): a multicentre, open-label, single-arm, phase 1 trial. Lancet. 2016;387(10025):1298–304. https://doi.org/10.1016/S0140-6736(16)00704-2.CrossRefPubMedGoogle Scholar
- 24.Kaye DM, Hasenfuss G, Neuzil P, Post MC, Doughty R, Trochu JN, et al. One-year outcomes after transcatheter insertion of an interatrial shunt device for the management of heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(12):e003662. https://doi.org/10.1161/CIRCHEARTFAILURE.116.003662.
- 26.•• Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733–79. This is the current ESC guideline for hypertrophic cardiomyopathy. CrossRefPubMedGoogle Scholar
- 27.•• Veselka J, Jensen MK, Liebregts M, Januska J, Krejci J, Bartel T, et al. Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry. Eur Heart J. 2016;37(19):1517–23. This is the first report from the Euro-ASA registry, the largest multinational study cohort. CrossRefPubMedGoogle Scholar
- 28.• Veselka J, Faber L, Liebregts M, Cooper R, Januska J, Krejci J, et al. Outcome of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy: a long-term follow-up study based on the euro-alcohol septal ablation registry. J Am Heart Assoc. 2017;6(5). https://doi.org/10.1161/JAHA.117.005735. This report describes the results of alcohol septal ablation in mildly symptomatic patients with hypertrophic obstructive cardiomyopathy.
- 29.• Liebregts M, Faber L, Jensen MK, Vriesendorp PA, Januska J, Krejci J, et al. Outcomes of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy. JACC Cardiovasc Interv. 2017;10(11):1134–43. This report describes the results of alcohol septal ablation in younger patients with hypertrophic obstructive cardiomyopathy. CrossRefPubMedGoogle Scholar
- 30.• Schäfer U, Kreidel F, Frerker C. MitraClip implantation as a new treatment strategy against systolic anterior motion-induced outflow tract obstruction in hypertrophic obstructive cardiomyopathy. Heart Lung Circ. 2014;23(5):e131–5. This is the first report of MitraClip® therapy for hypertrophic obstructive cardiomyopathy. CrossRefPubMedGoogle Scholar
- 31.Schäfer U, Frerker C, Thielsen T, Schewel D, Bader R, Kuck KH, et al. Targeting systolic anterior motion and left ventricular outflow tract obstruction in hypertrophic obstructed cardiomyopathy with a MitraClip. EuroIntervention. 2015;11(8):942–7. https://doi.org/10.4244/EIJY14M08_13.CrossRefPubMedGoogle Scholar