Safety and efficacy of less-invasive ventricular enhancement procedure with the transcatheter Revivent TCTM system in patients with left ventricular aneurysm: a systematic review.

Left ventricular (LV) aneurysm following acute myocardial infarction (MI) represents a less common complication, but with worse clinical outcomes. Ventricular surgical reconstruction is not always the intervention of choice due to high surgical risk. There were proposed less invasive LV aneurysm exclusion techniques such as the less invasive ventricular enhancement (LIVE) procedure. Our paper represents the first systematic approach to investigate the efficacy and safety of LIVE procedure using Revivent TCTM anchor system for LV aneurysm exclusion. Studies were considered if they reported original data regarding LIVE procedure's efficacy and/or safety using the Revivent TCTM system in patients with LV aneurysms. Five studies met the inclusion criteria. The procedure is associated with a reduction in LV volumes and an improvement in LV ejection fraction (LVEF). The means of preoperative LVEF varied between 22.8% and 35.6%, while postoperative LVEF means ranged between 34% and 45.9% (P < 0.005) across studies. All included papers reported a significant difference between preoperative and postoperative LV end-systolic volume index (P ≤ 0.001) and LV end-diastolic volume index (P ≤ 0.001). Three out of four studies achieved statistical significance (P ≤ 0.001) when comparing preoperative (means range: 2.6-3.4) and postoperative (means range: 1.4-1.9) New York Heart Association (NYHA) class. One study reported a survival rate of 90.6 (95% CI, 84.6-97.0) at 12 months following the procedure. LIVE appears to be a promising and appropriate treatment strategy for a complex condition, which could extend the indication of LV aneurysm exclusion in the future.

Coronary revascularization during treatment of severe aortic stenosis: A meta-analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR).

BACKGROUND: The management of patients with coexisting severe aortic stenosis (AS) and coronary artery disease (CAD) is still facing a great deal of uncertainty when it comes to choosing between the entire surgical versus the complete percutaneous approaches, after accurately balancing risks versus outcomes. AIM: To evaluate clinical outcomes and mortality of transcatheter aortic valve replacement (TAVR) plus percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary arteries bypass grafting (CABG) procedures in patients with concomitant AS and CAD. METHODS: Electronic databases of PubMed, EMBASE, and SCOPUS were searched for relevant articles assessing outcome parameters of interest. The study endpoints were the rate of overall myocardial infarction and stroke within 30 days and the rate of 30-day mortality and 2-year mortality between patients with TAVR/PCI and those with SAVR/CABG. RESULTS: Random-effect meta-analysis did not reveal any significant difference between 30-day safety outcomes: myocardial infarction (TAVR/PCI vs SAVR/CABG: odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.20-1.33; I2 = 0%), stroke (TAVR/PCI vs SAVR/CABG: OR: 0.88; 95% CI: 0.45-1.73; I2 = 0%). No significant difference in 30-day mortality (OR: 0.72; 95% CI: 0.43-1.21; I2 = 0%) and 2-year mortality (OR: 1.50; 95% CI: 0.77-2.94; I2 = 81%) rate was noted between patients with TAVR/PCI and those with SAVR/CABG. CONCLUSIONS: When comparing the total percutaneous and total surgical treatment, no significant difference in short-term safety outcomes or early and late mortality was observed. More evidence is needed to guide the clinical decision.