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Sebastian SA, Co EL, Mahtani A, Padda I, Anam M, Mathew SS, Shahzadi A, Niazi M, Pawar S, Johal G. Heart Failure: Recent Advances and Breakthroughs. Dis Mon 2024; 70:101634. [PMID: 37704531 DOI: 10.1016/j.disamonth.2023.101634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Heart failure (HF) is a common clinical condition encountered in various healthcare settings with a vast socioeconomic impact. Recent advancements in pharmacotherapy have led to the evolution of novel therapeutic agents with a decrease in hospitalization and mortality rates in HF with reduced left ventricular ejection fraction (HFrEF). Lately, the introduction of artificial intelligence (AI) to construct decision-making models for the early detection of HF has played a vital role in optimizing cardiovascular disease outcomes. In this review, we examine the newer therapies and evidence behind goal-directed medical therapy (GDMT) for managing HF. We also explore the application of AI and machine learning (ML) in HF, including early diagnosis and risk stratification for HFrEF.
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Affiliation(s)
| | - Edzel Lorraine Co
- University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines
| | - Arun Mahtani
- Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Inderbir Padda
- Richmond University Medical Center/Mount Sinai, Staten Island, New York, USA
| | - Mahvish Anam
- Deccan College of Medical Sciences, Hyderabad, India
| | | | | | - Maha Niazi
- Royal Alexandra Hospital, Edmonton, Canada
| | | | - Gurpreet Johal
- Department of Cardiology, University of Washington, Valley Medical Center, Seattle, Washington, USA
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2
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Chouairi F, Levin A, Biegus J, Fudim M. Emerging devices for heart failure management. Prog Cardiovasc Dis 2024; 82:125-134. [PMID: 38242194 DOI: 10.1016/j.pcad.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/21/2024]
Abstract
There have been significant advances in the treatment of heart failure (HF) in recent years, driven by significant strides in guideline-directed medical therapy (GDMT). Despite this, HF is still associated with high levels of morbidity and mortality, and most patients do not receive optimal medical therapy. In conjunction with the improvement of GDMT, novel device therapies have been developed to better treat HF. These devices include technology capable of remotely monitoring HF physiology, devices that modulate the autonomic nervous system, and those that structurally change the heart with the ultimate aim of addressing the root causes of HF physiology As these device therapies gradually integrate into the fabric of HF patient care, it becomes increasingly important for modern cardiologists to become familiar with them. Hence, the objective of this review is to shed light on currently emerging devices for the treatment of HF.
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Affiliation(s)
- Fouad Chouairi
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Allison Levin
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Marat Fudim
- Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Duke Clinical Research Institute, Durham, NC, USA.
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3
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Salah HM, Fudim M, Burkhoff D. Device Interventions for Heart Failure. JACC. HEART FAILURE 2023; 11:1039-1054. [PMID: 37611987 DOI: 10.1016/j.jchf.2023.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/25/2023]
Abstract
Despite remarkable advances in drug therapy for heart failure (HF), the residual HF-related morbidity, mortality, and hospitalizations remain substantial across all HF phenotypes, and significant proportions of patients with HF remain symptomatic despite optimal drug therapy. Driven by these unmet clinical needs, the exponential growth of transcatheter interventions, and a recent shift in the regulatory landscape of device-based therapies, novel device-based interventions have emerged as a potential therapy for various phenotypes of HF. Device-based interventions can overcome some of the limitations of drug therapy (eg, intolerance, nonadherence, inconsistent delivery, and recurrent and long-term cost) and can target some HF-related pathophysiologic pathways more effectively than drug therapy. This paper reviews the current evolving landscape of device-based interventions in HF and highlights critical points related to implementation of these therapies in the current workflow of HF management.
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Affiliation(s)
- Husam M Salah
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, New York, USA.
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4
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Hamid N, Jorde UP, Reisman M, Latib A, Lim DS, Joseph SM, Kurlianskaya A, Polonetsky O, Neuzil P, Reddy V, Foerst J, Gada H, Grubb KJ, Silva G, Kereiakes D, Shreenivas S, Pinney S, Davidavicius G, Sorajja P, Boehmer JP, Kleber FX, Perier P, VAN Mieghem NM, Dumonteil N, Leon MB, Burkhoff D. Transcatheter Left Ventricular Restoration in Patients With Heart Failure. J Card Fail 2023; 29:1046-1055. [PMID: 36958391 DOI: 10.1016/j.cardfail.2023.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Left ventricular (LV) volume reshaping reduces myocardial wall stress and may induce reverse remodeling in patients with heart failure with reduced ejection fraction. The AccuCinch Transcatheter Left Ventricular Restoration system consists of a series of anchors connected by a cable implanted along the LV base that is cinched to the basal free wall radius. We evaluated the echocardiographic and clinical outcomes following transcatheter left ventricular restoration. METHODS AND RESULTS We analyzed 51 heart failure patients with a left ventricular ejection fraction between 20% and 40%, with no more than 2+ mitral regurgitation treated with optimal medical therapy, who subsequently underwent transcatheter left ventricular restoration. Serial echocardiograms, Kansas City Cardiomyopathy Questionnaire scores, and 6-minute walk test distances were measured at baseline through 12 months. Primary analysis end point was change in end-diastolic volume at 12 months compared with baseline. Patients (n = 51) were predominantly male (86%) with a mean age of 56.3 ± 13.1 years. Fluoroscopy showed LV free wall radius decreased by a median of 9.2 mm amounting to a 29.6% decrease in the free wall arc length. At 12 months, the LV end-diastolic volume decreased by 33.6 ± 34.8 mL (P < .01), with comparable decreases in the LV end-systolic volume. These decreases were associated with significant improvements in the overall Kansas City Cardiomyopathy Questionnaire score (16.4 ± 18.7 points; P < .01) and 6-minute hall walk test distance (45.9 ± 83.9 m; P < .01). There were no periprocedural deaths; through the 1-year follow-up, 1 patient died (day 280) and 1 patient received a left ventricular assist device (day 13). CONCLUSIONS In patients with heart failure with reduced ejection fraction without significant mitral regurgitation receiving optimal medical therapy, the AccuCinch System resulted in decreases of LV volume, as well as improved quality of life and exercise endurance. A randomized trial is ongoing (NCT04331769).
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Affiliation(s)
- Nadira Hamid
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Ulrich P Jorde
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | | | - Azeem Latib
- Montefiore Medical Center, New York, New York; Albert Einstein College of Medicine, Bronx, New York
| | - D Scott Lim
- University of Virginia, Charlottesville, Virginia
| | - Susan M Joseph
- University of Maryland Medical Center, Baltimore, Maryland
| | | | - Oleg Polonetsky
- Republican Scientific and Practical Center Cardiology, Minsk, Belarus
| | | | - Vivek Reddy
- Icahn School of Medicine Mount Sinai, New York, New York
| | - Jason Foerst
- Carilion Roanoke Memorial Hospital, Roanoke, Virginia
| | - Hemal Gada
- UPMC Heart and Vascular Institute, Pinnacle Health, Harrisburg, Pennsylvania
| | | | | | | | | | - Sean Pinney
- University of Chicago, Division of Cardiology, Chicago, Illinois
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, and Cardiology and Angiology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Paul Sorajja
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | | | - Franz X Kleber
- Martin Luther Universität Halle-Wittenberg, PGS Wittenberg, Germany
| | - Patrick Perier
- Campus Bad Neustadt, Herzchirurgie, Bad Neustadt/Saale, Germany
| | - Nicolas M VAN Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Martin B Leon
- Columbia University Medical Center/ NY Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
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5
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Katzianer D, Albert C. Structural Interventions in Heart Failure: Mending a Broken Heart. J Clin Med 2023; 12:jcm12093243. [PMID: 37176681 PMCID: PMC10179306 DOI: 10.3390/jcm12093243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Advanced heart failure is often accompanied by perturbations in cardiac chamber or valve geometries which result in worsening cardiac function and hemodynamics. Once limited to surgical procedures, recent developments in minimally invasive percutaneous techniques have demonstrated efficacy in patients with both reduced and preserved ejection fraction who are at an elevated surgical risk for perioperative events. This review highlights a subset of the interventions available in clinical practice or in development for the treatment of these valvular and structural alterations.
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Affiliation(s)
- David Katzianer
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Chonyang Albert
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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6
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Spilias N, Howard TM, Anthony CM, Laczay B, Soltesz EG, Starling RC, Sievert H, Estep JD, Kapadia SR, Puri R. Transcatheter left ventriculoplasty. EUROINTERVENTION 2023; 18:1399-1407. [PMID: 37092265 PMCID: PMC10113960 DOI: 10.4244/eij-d-22-00544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/07/2022] [Indexed: 04/25/2023]
Abstract
Despite significant advances in pharmacological, electrophysiological and valve therapies for heart failure with reduced ejection fraction (HFrEF), the associated morbidity, mortality and healthcare costs remain high. With a constantly growing heart failure population, the existing treatment gap between current and advanced heart failure therapies (e.g., left ventricular [LV] assist devices, heart transplantation) reflects a large unmet need, calling for novel therapeutic approaches. Left ventricular remodelling and dilatation, with or without scar formation, is the hallmark of cardiomyopathy and is associated with poor prognosis. In the era of exciting advances in structural heart interventions, the advent of minimally invasive, device-based therapies directly targeting the LV geometry and promoting physical reverse remodelling has created a new frontier in the battle against heart failure. Interventional heart failure therapy is a rapidly emerging field, encompassing structural heart and minimally invasive hybrid procedures, with two left ventriculoplasty devices currently under investigation in pivotal clinical trials in the US. This review addresses the rationale for left ventriculoplasty, presents the prior surgical and percutaneous attempts in the field, provides an overview of the novel transcatheter left ventriculoplasty devices and their respective trials, and highlights potential challenges associated with establishing such device-based therapies in our armamentarium against heart failure.
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Affiliation(s)
- Nikolaos Spilias
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Travis M Howard
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chris M Anthony
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Balint Laczay
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward G Soltesz
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Randall C Starling
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jerry D Estep
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
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7
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Hegeman RRMJJ, McManus S, van Kuijk JP, Harb SC, Swaans MJ, Klein P, Puri R. Inward Displacement: A Novel Method of Regional Left Ventricular Functional Assessment for Left Ventriculoplasty Interventions in Heart Failure with Reduced Ejection Fraction (HFrEF). J Clin Med 2023; 12:jcm12051997. [PMID: 36902783 PMCID: PMC10003768 DOI: 10.3390/jcm12051997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Hybrid minimally invasive left ventricular reconstruction is used to treat patients with ischemic heart failure with reduced ejection fraction (HFrEF) and antero-apical scar. Pre- and post-procedural regional functional left ventricular assessment with current imaging techniques remains limited. We evaluated 'inward displacement' as a novel technique of assessing regional left ventricular function in an ischemic HFrEF population who underwent left ventricular reconstruction with the Revivent System. METHODS Inward displacement adopts three standard long-axis views obtained during cardiac MRI or CT and assesses the degree of inward endocardial wall motion towards the true left ventricular center of contraction. For each of the standard 17 left ventricular segments, regional inward displacement is measured in mm and expressed as a percentage of the maximal theoretical distance each segment can contract towards the centerline. The left ventricle was divided into three regions, obtaining the arithmetic average of inward displacement or speckle tracking echocardiographic strain at the left ventricular base (segments 1-6), mid-cavity (segments 7-12) and apex (segments 13-17). Inward displacement was measured using computed tomography or cardiac magnetic resonance imaging and compared pre- and post-procedurally in ischemic HFrEF patients who underwent left ventricular reconstruction with the Revivent System (n = 36). In a subset of patients who underwent baseline speckle tracking echocardiography, pre-procedural inward displacement was compared with left ventricular regional echocardiographic strain (n = 15). RESULTS Inward displacement of basal and mid-cavity left ventricular segments increased by 27% (p < 0.001) and 37% (p < 0.001), respectively, following left ventricular reconstruction. A significant overall decrease in both the left ventricular end systolic volume index and end diastolic volume index of 31% (p < 0.001) and 26% (p < 0.001), respectively, was detected, along with a 20% increase in left ventricular ejection fraction (p = 0.005). A significant correlation between inward displacement and speckle tracking echocardiographic strain was noted within the basal (R = -0.77, p < 0.001) and mid-cavity left ventricular segments (R = -0.65, p = 0.004), respectively. Inward displacement resulted in relatively larger measurement values compared to speckle tracking echocardiography, with a mean difference of absolute values of -3.33 and -7.41 for the left ventricular base and mid-cavity, respectively. CONCLUSIONS Obviating the limitations of echocardiography, inward displacement was found to highly correlate with speckle tracking echocardiographic strain to evaluate regional segmental left ventricular function. Significant improvements in basal and mid-cavity left ventricular contractility were demonstrated in ischemic HFrEF patients following left ventricular reconstruction of large antero-apical scars, consistent with the concept of reverse left ventricular remodeling at a distance. Inward displacement holds significant promise in the HFrEF population being evaluated pre- and post-left ventriculoplasty procedures.
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Affiliation(s)
- Romy R. M. J. J. Hegeman
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
- Correspondence: ; Tel.: +31-(0)631-103-506
| | | | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Serge C. Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Martin J. Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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8
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Tang R, Chang Y, Song J. Advances in novel devices for the treatment of heart failure. Heart Fail Rev 2023; 28:331-345. [PMID: 36792818 DOI: 10.1007/s10741-022-10293-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 02/17/2023]
Abstract
Heart failure (HF) is one of the leading causes of global health impairment. Current drugs are still limited in their effectiveness in the treatment and reversal of HF: for example, drugs for acute HF (AHF) help to reduce congestion and relieve symptoms, but they do little to improve survival; most conventional drugs for HF with preserved ejection fraction (HFpEF) do not improve the prognosis; and drugs have extremely limited effects on advanced HF. In recent years, progress in device therapies has bridged this gap to a certain extent. For example, the availability of the left ventricular assist device has brought new options to numerous advanced HF patients. In addition to this recognizable device, a range of promising novel devices with preclinical or clinical trial results are emerging that seek to treat or reverse HF by providing circulatory support, repairing structural abnormalities in the heart, or providing electrical stimulation. These devices may be useful for the treatment of HF. In this review, we summarized recent advances in novel devices for AHF, HFpEF, and HF with reduced ejection fraction (HFrEF) with the aim of providing a reference for clinical treatment and inspiration for novel device development.
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Affiliation(s)
- Renjie Tang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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9
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Ma S, Chen L, Yan J, Shen M, Zhang R, Li M, He M, Chen K, Zhu Y, Lin H, Wang Y, Liao W, Bin J, Zheng C, Liao Y. Dapagliflozin attenuates residual cardiac remodeling after surgical ventricular reconstruction in mice with an enlarged heart after myocardial infarction. Biomed Pharmacother 2022; 156:113765. [PMID: 36228368 DOI: 10.1016/j.biopha.2022.113765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Severe heart failure refractory to conventional therapy requires alternative treatment modalities. Surgical ventricular reconstruction (SVR) has been used to reverse cardiac remodeling in post-myocardial infarction (MI) patients with large left ventricular (LV) aneurysm, however, residual LV remodeling and dysfunction remain postoperatively. It is unclear whether SVR recovers response to drug treatment and whether the sodium-glucose co-transporter 2 inhibitor dapagliflozin (DAPA) reverses residual LV remodeling after SVR. METHODS Adult male C57 mice were subjected to MI or sham surgery. Four-week later, MI mice with LV aneurysm underwent modified SVR or second open-chest sham operation and were randomized to DAPA or vehicle for four-week. Cardiac remodeling, LV function, and the underlying mechanisms were evaluated by echocardiography, invasive LV hemodynamic measurements, mRNA sequencing, and bioinformatics analysis. RESULTS SVR significantly decreased LV volume; increased myocardial strain, LV pressure change rates and end-systolic elastance; and decreased heart-to-body weight ratio and myocardial fibrosis. However, significant residual cardiac remodeling remained. DAPA significantly attenuated residual cardiac remodeling and improved LV function in SVR mice but did not have curative effects in non-SVR mice. Of the 1532 genes differentially expressed in SVR and MI mice, 1037 were associated with cardiac metabolism; Src, Crebbp, Fn1, Grb2, and Mapk14 were the top 5 hub genes. Unlike sham surgery, MI upregulated those 5 genes, and treatment with SVR + DAPA normalized their expression. CONCLUSIONS SVR restores therapeutic response in the post-MI heart with large LV aneurysm, and DAPA attenuates residual cardiac remodeling after SVR by normalizing some cardiac metabolism-related hub genes.
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Affiliation(s)
- Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Lu Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Junyu Yan
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mengjia Shen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Rui Zhang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingjue Li
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingyuan He
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Kaitong Chen
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yingqi Zhu
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuegang Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Cankun Zheng
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Province Key Laboratory of Cardiac Function and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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10
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Hegeman RR, Swaans MJ, Van Kuijk JP, Klein P. Midterm Outcome of Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for the Treatment of Ischemic Heart Failure. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100081. [PMID: 37288056 PMCID: PMC10242554 DOI: 10.1016/j.shj.2022.100081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/06/2022] [Accepted: 07/15/2022] [Indexed: 06/09/2023]
Abstract
Background Left ventricular (LV) remodeling after anterior myocardial infarction (AMI) can cause a pathological increase in LV volume, reduction in LV ejection fraction (EF), and symptomatic heart failure (HF). This study evaluates the midterm results of a hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodeled LV by myocardial scar plication and exclusion with microanchoring technology. Methods Retrospective single-center analysis of patients who underwent hybrid LV reconstruction (LVR) with the Revivent TransCatheter System. Patients were accepted for the procedure when they presented with symptomatic HF (New York Heart Association class ≥ II, EF < 40%) after AMI, in the presence of a dilated LV with either akinetic or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Results Between October 2016 and November 2021, 30 consecutive patients were operated. Procedural success was 100%. Comparing echocardiographic data preoperatively and directly postoperatively, LVEF increased from 33 ± 8% to 44 ± 10% (p < 0.0001). LV end-systolic volume index decreased from 58 ± 24 mL/m2 to 34 ± 19 mL/m2 (p < 0.0001) and LV end-diastolic volume index decreased from 84 ± 32 mL/m2 to 58 ± 25 mL/m2 (p < 0.0001). Hospital mortality was 0%. After a mean follow-up of 3.4 ± 1.3 years, there was a significant improvement of New York Heart Association class (p = 0.001) with 76% of surviving patients in class I-II. Conclusions Hybrid LVR for symptomatic HF after AMI is safe and results in significant improvement in EF, reduction in LV volumes, and sustained improvement in symptoms.
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Affiliation(s)
- Romy R.M.J.J. Hegeman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Martin J. Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan-Peter Van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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11
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Hegeman RRMJJ, Swaans MJ, van Kuijk JP, Klein P. State-of-the-Art Review: Technical and Imaging Considerations in Hybrid Transcatheter and Minimally Invasive Left Ventricular Reconstruction for Ischemic Heart Failure. J Clin Med 2022; 11:jcm11164831. [PMID: 36013071 PMCID: PMC9409787 DOI: 10.3390/jcm11164831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/01/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Negative left ventricular (LV) remodeling consequent to acute myocardial infarction (AMI) is characterized by an increase in LV volumes in the presence of a depressed LVEF. In order to restore the shape, size, and function of the LV, operative treatment options to achieve volume reduction and shape reconstruction should be considered. In the past decade, conventional surgical LV reconstruction through a full median sternotomy has evolved towards a hybrid transcatheter and less invasive LV reconstruction. In order to perform a safe and effective hybrid LV reconstruction, thorough knowledge of the technical considerations and adequate use of multimodality imaging both pre- and intraoperatively are fundamental. In addition, a comprehensive understanding of the individual procedural steps from both a cardiological and surgical point of view is required.
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Affiliation(s)
| | - Martin John Swaans
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
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12
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Stone GW, Sievert H, Virmani R, Shaler LW, Manash B, Neustadter D. Description, Feasibility, and Histological Assessment of the Vsling, a Novel Transcatheter Ventricular Repair Device. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100075. [PMID: 37288331 PMCID: PMC10242562 DOI: 10.1016/j.shj.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 06/09/2023]
Abstract
Background Reshaping the dilated left ventricle using a surgically implanted papillary muscle sling has been shown to provide long-term improvement in cardiac function compared to annuloplasty alone in patients with systolic heart failure. A papillary muscle sling which can be implanted via a transcatheter approach has the potential to make this treatment more widely available to patients. Methods The Vsling transcatheter papillary muscle sling device was evaluated in a chronic animal model (sacrificed at 30 and 90 days), in a simulator, and in a human cadaver. Results The Vsling device was successfully implanted in 10 pigs, 6 simulator procedures, and 1 human cadaver. Procedure complexity and device usability were rated as reasonable or better by 6 interventional cardiologists. Gross and histological analysis in chronic pigs through 90 days demonstrated near-complete endothelial coverage with mild inflammation and small hematoma formation but without adverse tissue reactions, thrombi, or embolization. Conclusions Preliminary feasibility and safety of the Vsling implant and implantation procedure have been demonstrated. Human trials are planned to begin in the summer of 2022.
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Affiliation(s)
- Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt CVC, Frankfurt, Germany
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13
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Catheter-Based Management of Heart Failure: Pathophysiology and Contemporary Data. Interv Cardiol Clin 2022; 11:267-277. [PMID: 35710282 PMCID: PMC9797841 DOI: 10.1016/j.iccl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Device therapy for severe heart failure (HF) has shown efficacy both in acute and chronic settings. Recent percutaneous device innovations have pioneered a field known as interventional HF, providing clinicians with a variety of options for acute decompensated HF that are centered on nonsurgical mechanical circulatory support. Other structural-based therapies are aimed at the pathophysiology of chronic HF and target the underlying etiologies such as functional mitral regurgitation, ischemic cardiomyopathy, and increased neurohumoral activity. Remote hemodynamic monitoring devices have also been shown to be efficacious for the ambulatory management of HF. We review the current data on devices and investigational therapies for HF management whereby pharmacotherapy falls short.
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14
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Popov AF, Hanke T. LIVE™ – eine innovative Option zur minimal-invasiven Infarkttherapie durch operative Ventrikelrekonstruktion ohne Herz-Lungen-Maschine. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Abstract
PURPOSE OF REVIEW Despite advances in heart failure (HF) therapies, the associated morbidity, mortality, hospitalization rates, and healthcare expenditures remain high. A significant proportion of patients with HF remain symptomatic despite receiving optimal medical therapy. Consequently, there exists a large unmet clinical need for novel therapies for treating acute and chronic HF. With the exponential growth of transcatheter interventions in structural heart disease, novel applications of minimally invasive, device-based therapies have been sought in an effort to bridge this treatment gap. The rationale, development, and current data underscoring these therapies will be summarized in this review. RECENT FINDINGS Recent studies have demonstrated the safety and efficacy of devices that alter left ventricular geometry (i.e., ventriculoplasty), create anatomic shunts to decompress the left atrium, and modulate vena caval and renal blood flow. However pivotal large trials evaluating clinical outcomes are ongoing. SUMMARY Innovative device-based therapies may expand our armamentarium against the growing heterogeneous and morbid HF syndrome.
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16
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Kir D, Munagala M. Restructuring the Heart From Failure to Success: Role of Structural Interventions in the Realm of Heart Failure. Front Cardiovasc Med 2022; 9:839483. [PMID: 35528834 PMCID: PMC9069206 DOI: 10.3389/fcvm.2022.839483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Heart failure through the spectrum of reduced (HFrEF), mid-range (or mildly reduced or HFmEF), and preserved ejection fraction (HFpEF), continues to plague patients' quality of life through recurrent admissions and high mortality rates. Despite tremendous innovation in medical therapy, patients continue to experience refractory congestive symptoms due to adverse left ventricular remodeling, significant functional mitral regurgitation (FMR), and right-sided failure symptoms due to significant functional tricuspid regurgitation (FTR). As most of these patients are surgically challenging for open cardiac surgery, the past decade has seen the development and evolution of different percutaneous structural interventions targeted at improving FMR and FTR. There is renewed interest in the sphere of left ventricular restorative devices to effect reverse remodeling and thereby improve effective stroke volume and patient outcomes. For patients suffering from HFpEF, there is still a paucity of disease-modifying effective medical therapies, and these patients continue to have recurrent heart failure exacerbations due to impaired left ventricular relaxation and high filling pressures. Structural therapies involving the implantation of inter-atrial shunt devices to decrease left atrial pressure and the development of implantable devices in the pulmonary artery for real-time hemodynamic monitoring would help redefine treatment and outcomes for patients with HFpEF. Lastly, there is pre-clinical data supportive of soft robotic cardiac sleeves that serve to improve cardiac function, can assist contraction as well as relaxation of the heart, and have the potential to be customized for each patient. In this review, we focus on the role of structural interventions in heart failure as it stands in current clinical practice, evaluate the evidence amassed so far, and review promising structural therapies that may transform the future of heart failure management.
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17
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Shi Z, Gao F, Liu W, He X. Comparative Efficacy of Dapagliflozin and Empagliflozin of a Fixed Dose in Heart Failure: A Network Meta-Analysis. Front Cardiovasc Med 2022; 9:869272. [PMID: 35445086 PMCID: PMC9013819 DOI: 10.3389/fcvm.2022.869272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/09/2022] [Indexed: 12/22/2022] Open
Abstract
Background The efficacy of dapagliflozin and empagliflozin in sodium-glucose cotransport-2 inhibitors (SGLT-2i) in patients with heart failure (HF) has been discovered. However, which drug could improve varied prognostic outcomes has not been elucidated. Hence, we compared their efficacies on the prognostic improvement of HF. Methods Databases including PubMed, EMBASE, Scopus, Google Scholars, and the Cochrane Library were searched for all related randomized controlled trials (RCTs) published from inception to 13 October 2021. Network meta-analyses were performed to generate matrices to show the effect size for pairwise comparison regarding all the interventions. Results Eventually a total of 11 RCTs were included in this study. For the primary endpoints, dapagliflozin was comparable with empagliflozin in hospitalization for HF, and empagliflozin (OR=0.70, 95%CI: 0.59–0.84) decreased the risk of exacerbation of HF over dapagliflozin. For the secondary endpoints, dapagliflozin was comparable with empagliflozin in cardiovascular (CV) death /hospitalization for HF, and for CV death, dapagliflozin (OR=0.78, 95%CI: 0.65–0.92) significantly reduced mortality over the placebo. For the tertiary endpoints, dapagliflozin (OR=0.80, 95%CI: 0.66–0.98) significantly decreased the mortality over empagliflozin in all-cause death, and neither drug significantly increased the risk of hypoglycemia. Recommendations Overall, 10 mg/day dapagliflozin may be the optimal recommendation for its premium and comprehensive effect on improving the prognosis of patients with HF compared to 10 mg/day empagliflozin.
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18
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A Glimpse Into the Future of Transcatheter Interventional Heart Failure Therapies. JACC Basic Transl Sci 2022; 7:181-191. [PMID: 35257045 PMCID: PMC8897161 DOI: 10.1016/j.jacbts.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023]
Abstract
HF affects millions of patients every year, adding a significant financial burden to global health care systems. This review discusses the role of novel transcatheter-based therapies for the management of HF. Ongoing clinical trials will provide answers on the potential clinical benefits of these technologies in HF outcomes.
Chronic heart failure is one of the most debilitating chronic conditions affecting millions of people and adding a significant financial burden to health care systems worldwide. Despite the significant therapeutic advances achieved over the last decade, morbidity and mortality remain high. Multiple catheter-based interventional therapies targeting different physiological and anatomical targets are already under different stages of clinical investigation. The present paper provides a technical overview of the most relevant catheter-based interventional therapies under clinical investigation.
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Key Words
- CI, confidence interval
- COVID-19, coronavirus disease 2019
- CS, coronary sinus
- CVP, central venous pressure
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HR, hazard ratio
- LA, left atrium/atrial
- LAP, left atrial pressure
- LV, left ventricular
- LVEDV, left ventricular end-diastolic volume
- LVEF, left ventricular ejection fraction
- LVESV, left ventricular end-systolic volume
- LVESVi, left ventricular end-systolic volume index
- NYHA, New York Heart Association
- PCWP, pulmonary capillary wedge pressure
- RA, right atrium/atrial
- RAP, right atrial pressure
- SVC, superior vena cava
- catheter-based therapies
- heart failure
- interventional heart failure
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19
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Hieda T, Shingu Y, Sugimoto S, Asai H, Yamakawa T, Wakasa S. Effects of trehalose on recurrence of remodeling after ventricular reconstruction in rats with ischemic cardiomyopathy. Heart Vessels 2022; 37:528-537. [PMID: 35013770 DOI: 10.1007/s00380-021-01990-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/12/2021] [Indexed: 12/09/2022]
Abstract
Recurrence of left ventricular (LV) remodeling after surgical ventricular reconstruction (SVR) for ischemic cardiomyopathy has been reported to be partially attributed to autophagy. We aimed to examine the effects of trehalose, an autophagy inducer, on the recurrence of LV remodeling after SVR. After SVR in rats with ICM, trehalose was orally administered. The changes in LV end-diastolic dimension (LVEDD) and fractional shortening (FS) were evaluated. The activation of myocardial autophagy was also estimated by autophagy markers: microtubule-associated light chain 3 II (LC3-II) and p62; the former usually increases and the latter decreases if autophagy is activated. Significant LV reverse remodeling was observed early after SVR. On the other hand, the 28th postoperative day SVR + trehalose was associated with smaller LVEDD and better FS than SVR alone (LVEDD, P = 0.043; FS, P < 0.01). LC3-II increased comparably in both groups, while p62 was significantly lower in the SVR + trehalose group than in the SVR alone group (P < 0.01). In conclusion, trehalose attenuated the recurrence of LV remodeling and changed autophagy markers after SVR in rats with ICM. Trehalose may be a candidate for adjuvant therapy to retain the effects of SVR.
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Affiliation(s)
- Tetsuya Hieda
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan.
| | - Satoshi Sugimoto
- Department of Cardiovascular Surgery, Obihiro Kosei Hospital, Obihiro, Japan
| | - Hidetsugu Asai
- Department of Cardiovascular Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Tomoji Yamakawa
- Department of Cardiovascular Surgery, Kinikyo Chuo Hospital, Sapporo, Japan
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido University, Kita 15, Nishi 7, Kitaku, Sapporo, 060-8638, Japan
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20
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Ma S, Yan J, Yang D, Liao W, Bin J, Lin H, Liao Y. A Modified Surgical Ventricular Reconstruction in Post-infarction Mice Persistently Alleviates Heart Failure and Improves Cardiac Regeneration. Front Cardiovasc Med 2022; 8:789493. [PMID: 35004900 PMCID: PMC8740235 DOI: 10.3389/fcvm.2021.789493] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives: Large ventricular aneurysm secondary to myocardial infarction (MI) results in severe heart failure (HF) and limits the effectiveness of regeneration therapy, which can be improved by surgical ventricular reconstruction (SVR). However, the conventional SVR procedures do not yield optimal long-term outcome in post-MI rodents. We hypothesized that a modified SVR procedure without aggressive purse string suture would persistently alleviate HF and improve cardiac regeneration in post-MI mice. Methods: Adult male C57 mice were subjected to MI or sham surgery. Four weeks later, mice with MI underwent SVR or 2nd open-chest operation alone. SVR was performed by plicating the aneurysm with a single diagonal linear suture from the upper left ventricle (LV) to the right side of the apex. Cardiac remodeling, heart function and myocardial regeneration were evaluated. Results: Three weeks after SVR, the scar area, LV volume, and heart weight/body weight ratio were significantly smaller, while LV ejection fraction, the maximum rising and descending rates of LV pressure, LV contractility and global myocardial strain were significantly higher in SVR group than in SVR-control group. The inhibitory effects of SVR on LV remodeling and HF persisted for at least eight-week. SVR group exhibited improved cardiac regeneration, as reflected by more Ki67-, Aurora B- and PH3-positive cardiomyocytes and a higher vessel density around the plication area of the infarcted LV. Conclusions: SVR with a single linear suture results in a significant and sustained reduction in LV volume and improvement in both LV systolic and diastolic function as well as cardiac regeneration.
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Affiliation(s)
- Siyuan Ma
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Junyu Yan
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dexuan Yang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wangjun Liao
- Department of Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hairuo Lin
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yulin Liao
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Shock and Microcirculation, National Clinical Research Center of Kidney Disease, Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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21
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Fudim M, Abraham WT, von Bardeleben RS, Lindenfeld J, Ponikowski PP, Salah HM, Khan MS, Sievert H, Stone GW, Anker SD, Butler J. Device Therapy in Chronic Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:931-956. [PMID: 34446165 PMCID: PMC9941752 DOI: 10.1016/j.jacc.2021.06.040] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Piotr P. Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland,Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, AR, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
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22
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Scheiber D, Westenfeld R. Interventionelle LV-Modulation in der Herzinsuffizienztherapie. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1463-6104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungTrotz großer Fortschritte in der Akutversorgung des Myokardinfarkts entwickelt ein relevanter Teil der Patienten eine chronische Herzinsuffizienz. Der durch den Infarkt verursachte myokardiale Schaden kann pathologische Umbauprozesse im Herzen wie linksventrikuläre Dilatation, Veränderung der ventrikulären Geometrie und die Ausbildung von Narbengewebe initiieren, die in einer progredienten Herzinsuffizienzsymptomatik und -letalität resultieren können. Verschiedene chirurgische und interventionelle Therapieverfahren zur Modulation der pathologischen Umbauprozesse im Herzmuskel wurden entwickelt. Sie erwiesen sich als sicher und effektiv in der Reduktion linksventrikulärer Volumina, einer Steigerung der linksventrikulären Ejektionsfraktion sowie im Hinblick auf klinische Parameter. Randomisierte prospektive Studien, die einen Überlebensvorteil durch interventionelle oder chirurgische linksventrikuläre Modulation nachweisen, liegen zurzeit nicht vor.
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Affiliation(s)
- Daniel Scheiber
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ralf Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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23
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Long-Term Results of Hybrid Left Ventricular Reconstruction in the Treatment of Ischemic Cardiomyopathy. J Cardiovasc Transl Res 2021; 14:1043-1050. [PMID: 33974231 PMCID: PMC8651588 DOI: 10.1007/s12265-021-10133-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022]
Abstract
The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure.
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24
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Kilcoyne MF, Han JJ, Dewan KC, Wallen TJ, Nguyen TC. Training the trainee in structural heart disease: A need for change. J Thorac Cardiovasc Surg 2021; 163:2166-2170. [PMID: 33685736 DOI: 10.1016/j.jtcvs.2021.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/23/2023]
Affiliation(s)
| | - Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Krish C Dewan
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Tyler J Wallen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, The University of Florida, Gainesville, Fla
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, Houston, Tex
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25
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Walker JW, Cios TJ. Anesthetic Considerations for a Novel Method of Surgical Ventricular Remodeling Using the BioVentrix Revivent TC System. J Cardiothorac Vasc Anesth 2021; 35:2194-2200. [PMID: 33642169 DOI: 10.1053/j.jvca.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022]
Abstract
Surgical ventricular remodeling (SVR) is an invasive method of treating patients with heart failure who also have ischemic cardiomyopathy and reduced ejection fraction (EF). Introduced in the mid-1980s, this technique was met with varying success and relatively high morbidity and mortality despite its theoretical benefits. The development of the BioVentrix Revivent TC System (BioVentrix, Inc., San Ramon, CA) as a less-invasive method of surgical ventricular remodeling has created a novel, multidisciplinary approach to heart failure management, which necessitates multiple subspecialties. Currently in the trial phase in the United States and widely used in Europe, the positive results to date appear promising for the rapid adoption of this procedure. For the cardiac anesthesiologist, a thorough understanding of the patient population, procedural goals, and intraoperative management is essential. This overview discusses the advancement in surgical ventricular remodeling, the pertinent surgical steps of the BioVentrix Revivent TC System placement, and specific anesthetic considerations for this novel procedure.
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Affiliation(s)
- Justin W Walker
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Theodore J Cios
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
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26
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Ahmed R, Botezatu B, Nanthakumar M, Kaloti T, Harky A. Surgery for heart failure: Treatment options and implications. J Card Surg 2021; 36:1511-1519. [PMID: 33527493 DOI: 10.1111/jocs.15384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
Heart failure is considered one of the leading causes of death worldwide. Over the years, etiological risk factors, diagnostic criteria, and classifications have been revised to create guide management needed to alleviate the global health burden caused by heart failure. Pharmacological treatments have progressed over time but are insufficient in reducing mortality. This leads to many patients developing advanced heart failure who will require surgical intervention often in the form of the gold standard, a heart transplant. However, the number of patients requiring a transplant far exceeds the number of donors. Other surgical inventions have been utilized, yet the rate of patients being diagnosed with heart failure is still increasing. Future developments in the surgical field of heart failure include the 77SyncCardia and atrial shunting but long-term clinical trials involving larger cohorts of patients have not yet taken place to view how effective these approaches can be.
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Affiliation(s)
- Rukhsana Ahmed
- Medical School, St George's, University of London, Cranmer Terrace, UK
| | - Bianca Botezatu
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Tamara Kaloti
- Department of Epidemiology and Healthcare, University College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Cardiac surgery, Alder Hey NHS Foundation Trust, Liverpool, UK
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27
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Biffi M, Loforte A, Folesani G, Ziacchi M, Attinà D, Niro F, Pasquale F, Pacini D. Hybrid transcatheter left ventricular reconstruction for the treatment of ischemic cardiomyopathy. Cardiovasc Diagn Ther 2021; 11:183-192. [PMID: 33708491 DOI: 10.21037/cdt-20-265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Left ventricular (LV) enlargement is a mechanical adaptation to accommodate LV systolic inefficiency following an acute damage or a progressive functional deterioration, which fails to correct the decline of stroke volume in the long term, leading to progressive heart failure (HF). Surgical ventricular reconstruction (SVR) is a treatment for patients with severe ischemic HF aiming to restore LV efficiency by volume reduction and LV re-shaping. Recently, a new minimally-invasive hybrid technique for ventricular reconstruction has been developed by means of the Revivent™ system (BioVentrix Inc., San Ramon, CA, USA). The device for ventricular reconstruction consists of anchor pairs that enable plication of the anterior and free wall LV scar against the right ventricular (RV) septal scar of anteroseptal infarctions to decrease cardiac volume without ventriculotomy in a beating-heart minimally-invasive procedure, consisting of a transjugular and left thoracotomy approach. Patients with severe (Grade 4) functional mitral regurgitation (FMR) or with previous cardiac surgery procedures were excluded. Outcome of the reconstruction procedure: from 2012 until 2019, it has been applied to 203 patients, with 5 (2.5%) in-hospital deaths. LV volume reduction varied according to experience gained along years: LV end-systolic volume index decreased from baseline 43% (post-market registry) vs. 27% (CE-mark study); left ventricular ejection fraction (LVEF) increased from baseline 25% (post-market registry) vs. 16% (CE-mark study). Clinical status (NYHA class, HF questionnaire, 6-minute walking test) improved significantly compared to baseline, and re-hospitalization rate was only 13% at 6-month follow-up (60% of patients in NYHA =3). FMR grade decreased at follow-up in 63%, while it was unchanged in 37% of patients. The hybrid ventricular reconstruction (HVR) seems a promising treatment for HF patients who may benefit from LV volume reduction, with reasonable mortality and good results at follow-up. A baseline less severe clinical profile was not associated to better outcome at follow-up, which makes the procedure feasible in patients with very large ventricles and depressed ejection fraction (EF). LV reshaping has no detrimental effect on FMR, that may, on the contrary, benefit owing to less papillary muscle displacement, partial recovery of torsion dynamics and of myofibers re-orientation. A controlled study on top of optimal medical treatment is warranted to confirm its role in the management of HF patients.
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Affiliation(s)
- Mauro Biffi
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gianluca Folesani
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Niro
- Department of Radiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ferdinando Pasquale
- Department of Cardiology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Saia F, Loforte A, Pacini D. Innovative transcatheter procedures for the treatment of heart failure. Cardiovasc Diagn Ther 2021; 11:292-300. [PMID: 33708500 DOI: 10.21037/cdt-20-335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The prevalence of heart failure (HF) continues to rise over time, with aging of the population and increased survival of incident cases. Major improvements occurred in drug therapy but morbidity and mortality of HF patients remain high. Some non-pharmacologic approaches to HF are already part of standard treatment for HF, including implantable cardioverter-defibrillators, cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs). A number of transcatheter treatments and devices have been developed to improve management of valvular heart diseases (VHD), and some of them are being used or tested in specific HF conditions. For example, transcatheter aortic valve implantation (TAVI) to unload the left ventricle in patients with moderate aortic stenosis (AS) and HF or TAVI for severe aortic regurgitation (AR) in patients with LVADs. Similarly, percutaneous mitral valve repair can be used to improve prognosis and quality of life in patients with functional mitral valve regurgitation, and has been proposed as a bridge-to-LVAD or to heart transplant in selected patients. Other devices have been specifically developed for the treatment of chronic HF. In this review we describe the main devices used in the treatment of HF associated with aortic and mitral valve disease, as well as novel transcatheter interventions for chronic HF with different pathophysiologic targets.
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Affiliation(s)
- Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Antonino Loforte
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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29
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First Successful LVAD Implantation After BioVentrix Revivent TC Ventricular Reshaping. Ann Thorac Surg 2021; 112:e123-e126. [PMID: 33444578 DOI: 10.1016/j.athoracsur.2020.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
The Revivent TC System (BioVentrix Inc, San Ramon, CA) enables a less invasive approach for left ventricular reshaping and scar exclusion in selected patients with ischemic cardiomyopathy. Although the system is designed to improve quality of life and to promote reverse remodeling, patients can still progress to end-stage heart failure requiring advanced therapies. This report describes a case of left ventricular assist device surgery in a patient 16 months after Revivent System implantation. The planning process and surgical technique proved to be complex. This case report can help provide guidance to advanced heart failure teams who encounter patients with the Revivent System who require left ventricular assist device support.
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30
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Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Heart Fail 2020; 7:3505-3530. [PMID: 33277825 PMCID: PMC7754751 DOI: 10.1002/ehf2.13124] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
| | - Markus S Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité-University Medicine Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité-University Medicine Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Andrew J S Coats
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Cardiology and Cardiac Catheterization Laboratory, Cardio-thoracic Department, Civil Hospitals, Brescia, Italy
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Lipiecki J, Fahrat H, Monzy S, Caillot N, Siminiak T, Johnson T, Vogt S, Stark MA, Goldberg SL. Long-term prognosis of patients treated by coronary sinus-based percutaneous annuloplasty: single centre experience. ESC Heart Fail 2020; 7:3329-3335. [PMID: 33047896 PMCID: PMC7755003 DOI: 10.1002/ehf2.12955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/28/2020] [Accepted: 07/30/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS This study aims to report long-term mortality, echocardiographic, and clinical outcomes of patients receiving treatment for functional mitral regurgitation (FMR) with the Carillon device. METHODS AND RESULTS This was a single centre analysis of prospectively collected data from patients treated with the Carillon Mitral Contour System for symptomatic congestive heart failure despite guideline-directed medical therapy, who were included from a single centre from the TITAN II study. All patients presented with New York Heart Association (NYHA) class 2 or greater symptoms, grade 2+ to 4+ FMR, left ventricular enlargement, and reduced ejection fraction. Surviving patients were evaluated for long-term follow-up post-procedure, averaging 6.9 years. Fifteen (15) patients (mean age 72 years, 60% male, 100% NYHA class III or IV, 50% MR grade 3+ or 4+) were treated with the Carillon device. The Kaplan-Meier mortality rate was 40% at 6 years of follow-up. Long-term survival through 6 years was associated with echocardiographic improvement in mitral regurgitation (change in effective regurgitant orifice area in survivors versus non-survivors from baseline to 1 year follow-up, -9.0 ± 5.6 vs. -1.7 ± 1.5, P = 0.02) and clinical status at 12 months (difference in NYHA at 1 year follow-up between survivors versus non-survivors, P = 0. 05) which was sustained throughout follow-up. All patients at 6 year follow-up had ≤2+ MR, with 6 of 7 having 0-1+ MR. Left ventricular end-diastolic volume was reduced from 154.0 ± 65.7 mL at baseline to 104.5 ± 59.2 mL at 6 year follow-up, P = 0.03 in survivors with both measurements. CONCLUSIONS Among patients with congestive heart failure treated with the Carillon device, long-term survival is associated with favourable 1 year and sustained improvements in mitral regurgitation, left ventricular volume, ejection fraction, and clinical status.
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Affiliation(s)
- Janusz Lipiecki
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Hicham Fahrat
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Séverine Monzy
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Nicolat Caillot
- Centre de Cardiologie InterventionnelleElsan, Pôle Santé République99, Avenue de la RépubliqueClermont‐FerrandFrance
| | - Tomasz Siminiak
- Poznan University of Medical Sciences, HCP Medical CenterPoznanPoland
| | | | | | | | - Steven L. Goldberg
- Cardiac DimensionsKirklandWAUSA
- Tyler Heart Institute at Community Hospital of the Monterey PeninsulaMontereyCAUSA
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Castelvecchio S, Milani V, Volpe M, Citarella M, Ambrogi F, Boveri S, Saitto G, Garatti A, Menicanti L. Comparable outcomes between genders in patients undergoing surgical ventricular reconstruction for ischaemic heart failure. ESC Heart Fail 2020; 8:291-299. [PMID: 33169941 PMCID: PMC7835569 DOI: 10.1002/ehf2.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 01/18/2023] Open
Abstract
Aims Female sex and heart failure (HF) are considered poor prognostic factors for surgery. We aimed to investigate the association between sex and surgical outcomes in patients with ischaemic HF undergoing surgical ventricular reconstruction and coronary artery bypass grafting. Methods and results From July 2001 to June 2017, 648 patients [111 women (17%) and 537 men (83%)] were referred to our centre. Follow‐up continued through June 2018. All patients underwent surgical ventricular reconstruction; coronary artery bypass grafting was performed in 582 patients (90%). Primary outcome was defined as all‐cause mortality. Secondary outcome included all‐cause mortality or all‐cause hospitalization. Women were older (70 vs. 65 years, P < 0.0001) with lower body surface area (1.70 vs. 1.86 m2, P < 0.0001). Women had more diabetes (36% vs. 24%, P = 0.005) and a higher New York Heart Association classification (Class III/IV 65.7% vs. 47.8%, P = 0.0006), without any significant difference in medical therapy except for a higher use of oral antidiabetic agents in women (P = 0.029). At baseline, the left ventricular (LV) end‐diastolic volume index was significantly lower in women [median 107.06 (80.6–127.81) vs. 113. 04 (94.33–135.52) mL/m2, P = 0.0078] but not the LV end‐systolic volume index (ESVI) [median 73.45 (51.93–96.79) vs. 77.03 (60.33–95.71) mL/m2, P = 0.1393] and the ejection fraction (median 31% vs. 32%, P = 0.150). Women had a higher rate of anterior remodelling (90.9% vs. 79.1%, P = 0.0129), without evidence of differences in mitral valve insufficiency (P = 0.761 for Grade 0 to 4) and mitral surgery (P = 0.810). After surgery, the percentage of reduction in LV ESVI was higher in women than in men (median ΔLV ESVI −42.06 vs. −31.99, P = 0.0003). Mortality within 30 days occurred in 43 patients (6.64%): 12 women (10.81%) and 31 men (5.77%, P = 0.0522). Over a median follow‐up of 9.8 years, all‐cause mortality occurred in 269 patients (41.64%), without significant difference between women (45.9%) and men (40.7%). There was no evidence of difference of all‐cause death between sexes (log‐rank = 0.2441). When considering mortality and first hospitalization as competing events, Gray's test showed no difference of cumulative incidence functions (all‐cause hospitalization, all‐cause death, and combined endpoint) according to sex (P = 0.909, P = 0.445, and P = 0.429, respectively). Conclusions In this study, long‐term outcomes for women and men with ischaemic HF undergoing complex cardiac surgery were equivalent. Albeit older and more symptomatic, women should not be denied this type of cardiac surgery.
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Affiliation(s)
| | - Valentina Milani
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Marianna Volpe
- Department of Cardiac Rehabilitation, IRCCS Policlinico San Donato, Milan, Italy
| | - Michele Citarella
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, Milan, Italy
| | - Guglielmo Saitto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea Garatti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
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Calafiore AM, Prapas S, Katsavrias K, Di Marco M, Guarracini S, Di Mauro M. Left ventricular surgical remodeling 2.0. J Card Surg 2020; 36:298-299. [PMID: 33131115 DOI: 10.1111/jocs.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 11/28/2022]
Abstract
Left ventricular surgical remodeling has been, for a long time, the procedure applied for large dyskinetic, or akinetic, areas as a consequence of a myocardial infarction, mainly located in the left anterior descending area. Many surgical techniques were developed, aimed to a pure reduction of the volume of the left ventricular (LV) cavity or to add to volume reduction a more physiologic conical shape. The expansion of interventional procedures invaded most of the fields before treated only by cardiac surgeons. In this issue, Pillay describes a hybrid technique, involving both interventional cardiologists and cardiac surgeons, aimed to LV volume reduction after an anterior myocardial infarction. A series of internal (right ventricular septum) and external (anterior wall) anchors are implanted to approximate the LV free wall to the anterior septum, consequently excluding the scarred myocardium. Although some limitations of this study, the authors have to be commended for having revitalized a procedure almost eliminated from the surgical scenario.
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Affiliation(s)
| | - Sotirios Prapas
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Kostas Katsavrias
- Department of Cardiac Surgery, Henry Durant Hospital, Athens, Greece
| | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | | | - Michele Di Mauro
- Department of Cardiology, "Pierangeli" Hospital, Pescara, Italy.,Department of Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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34
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Commentary: Reshaping ventricular geometry of mice and men: How long is the string? J Thorac Cardiovasc Surg 2020; 163:e358-e359. [PMID: 32981706 DOI: 10.1016/j.jtcvs.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/22/2022]
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35
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Brener MI, Uriel N, Burkhoff D. Left Ventricular Volume Reduction and Reshaping as a Treatment Option for Heart Failure. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1777359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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36
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Klein P, Anker SD, Wechsler A, Kelle S. Left ventricular volume reduction and reshape - 'Re-STICHING' the field. Reply. Eur J Heart Fail 2020; 22:1053-1054. [PMID: 32463544 DOI: 10.1002/ejhf.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Patrick Klein
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Stefan D Anker
- BIH Center for Regenerative Therapies (BCRT), Charité, Universitätsmedizin Berlin, Berlin, Germany.,Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sebastian Kelle
- Department of Internal Medicine, Cardiology German Heart Center Berlin, Berlin, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
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37
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Behnes M, Schupp T, Mashayekhi K, Akin I. 'Off-pump' left ventricular reconstruction - A causal and less invasive surgical option for patients with advanced systolic heart failure? Eur J Heart Fail 2020; 22:581-583. [PMID: 32086997 DOI: 10.1002/ejhf.1737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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38
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Bonios MJ, Kogerakis N, Adamopoulos SN. Left ventricular volume reduction and reshape - 'Re-STICHING' the field. Letter regarding the article 'Less invasive ventricular reconstruction for ischaemic heart failure'. Eur J Heart Fail 2020; 22:1053. [PMID: 31975568 DOI: 10.1002/ejhf.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/29/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Michael J Bonios
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Nektarios Kogerakis
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, Athens, Greece
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