Minimally invasive hybrid technique for left ventricular aneurysm repair surgery due to ischemic cardiomyopathy

To the Editor, Chronic heart failure (CHF) is the third leading cause of cardiovascular death in developed countries, and is mostly of ischemic etiology.1 Despite the optimal medical therapy based on the clinical practice guidelines, many patients remain symptomatic for whom different procedures have become available over the last few years to stop pathological ventricular remodeling. The Revivent system (BioVentrix Inc., United States) is a hybrid ventricular reconstruction procedure that works by implanting micro-anchors via endovascular access and left mini thoracotomy to create a longitudinal plication of scar tissue without the need for mid sternotomy or extracorporeal circulation. Basically it is indicated in patients with ischemic heart disease and anterolateral or apical aneurysmal regions with transmural scar in both the left ventricle (LV) and right septum (RS)—according to the magnetic resonance imaging—to prevent muscle tears, and who still have persistent advanced CHF and NYHA functional class (FC) > III despite the optimal medical therapy.2 Biffi et al. confirmed an in-hospital mortality rate of 1.4%, and a 1-year survival rate of 90% in 203 patients.3 The STICH4 and RESTORE5 clinical trials revealed in-hospital mortality rates of 6% and 5.1%, respectively, and 18-month survival rates of 85% and 88%, respectively, after surgical therapy in patients...