Live Procedure for Ischemic Heart Failure: Contemporary Short- and Mid-Term Outcomes

Objectives: Ischemic cardiomyopathy is the principal cause of heart failure. In patients with left ventricular (LV) dilatation, low ejection fraction (EF), and transmural scar in anteroseptal distribution, surgical ventricular reconstruction (SVR) can be considered, although it is an invasive surgical procedure. Less Invasive Ventricular Enhancement (LIVE) technique emerged as a unique intervention to exclude scarred myocardium, improving symptoms and quality of life. We aim to present LIVE contemporary short and mid-term outcomes.

Methods: LIVE procedure has evolved from open sternotomy to a hybrid procedure done with right internal jugular vein access and a left minithoracotomy. LV shape and size are restored without extracorporeal circulation by plication of the scarred myocardium. This is achieved by implantation of a series of internal and external microanchors brought together over a poly-ether-ether-ketone (PEEK) tether to make a longitudinal approximation between the LV free wall and the anterior septum. Internal anchors are deployed by a transcatheter technique, through the right internal jugular vein, on the right side of the ventricular septum.

Result: Between July 2018 and August 2020, a total of 71 patients (84.5% men; mean age 61 ± 12.3 years) were submitted to the LIVE procedure in 18 institutions in Europe, North America, and Asia. Procedural success was 100%. A mean of 2.4 anchor pairs (median 3) was used to reshape the LV. Echocardiographic data showed an increase in LV EF from 31.0 ± 9.2 to 38.9 ± 12.6% (change +29.8%, p < 0.001) and LV end-systolic volume index (LVESVI) reduction from 68.0 ± 28.8 mL/m² to 42.3 ± 20.7 mL/m² (change: -37.9%, p < 0.001) after the procedure. No sternotomy conversion was needed. New onset tricuspid valve regurgitation was observed in one patient. There was no case of ventricular septal defect. Observed mortality was 2.8% (2 patients): one due to severe contrast dye induced anaphylactic shock and another one due to COVID-19. In the follow-up, NYHA class improved a median of 1 grade and there was no late mortality.

Conclusion: Hybrid LV reshaping and volume reduction has proven to be a useful solution for patients with symptomatic heart failure after left anterior descending territory myocardial infarction. These results from the latest iteration of the technique show that this approach is safe, reproducible, and has a significant short and mid-term impact on improving EF and reducing LV size.