Biological myocardial revascularization as a complementary therapy when combined with surgical myocardial revasculatization
Preliminary communication of a case and control prospective, randomized and double-blind study
Keywords:
MYOCARDIAL ISCHEMIA, MYOCARDIAL REVASCULARIZATION, CELL THERAPY, BONE MARROWAbstract
Introduction: incomplete surgical myocardial revascularization is a determining factor for early flare of subsequent angina which results in lower patient survival.
Objective: the present study aims to evaluate the perfusional efficacy of cell angiogenic therapy, using autologic bone-marrow derived stem cells, by means of direct intramyocardial injections, as a complementary therapy when combined with myocardial surgical revascularization.
Method: perfusional assessment subsequent to surgery is performed after three, six and twelve months with Single Photon Emission Computed Tomography (SPECT) and DTI-Strain.
Results: the present preliminary communication/notice (preceded by eight pilot cases) reports results obtained in four patients (two cases and two controls), completed follow-up in the third month, all of which evidenced chronic right coronary (RC) occlusion with no reversal, 50% average left ventricle ejection fraction. An average of 5.7 x 106 CD34+ autologic cells was injected into the descending posterior and posterolateral territory. The average injection volume was 5 ml per territory. Upon SPECT perfusional control in the third month, a 10% perfusional increase was detected in the injected territories. As to the control cases, nonrevascularized myocardial sectors evidenced a perfusional decrease of 3%, on average. DTI-Strain showed values improvement for all samples studied in the case of the preserved left ventricle ejection fraction (LVEF), and worsening in the LVEF lower range.
Angiogenic cell therapy by intramyocardial autologic bone-marrow stem cells implies perfusional benefits. It is a feasible and safe technique to complement surgical treatment.
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