Catheter-based autologous bone marrow myocardial injection in no-option patients with advanced coronary artery disease: a feasibility study.
OBJECTIVE
We conducted a pilot study to evaluate the feasibility of transendocardial delivery of autologous bone marrow (ABM) strategy in patients with severe symptomatic chronic myocardial ischemia not amenable to conventional revascularization.


BACKGROUND
Transendocardial injection of ABM cells appears to enhance perfusion of ischemic porcine myocardium.


METHODS
Ten patients underwent transendocardial injection of freshly aspirated and filtered unfractionated ABM using left ventricular electromechanical guidance. Twelve injections of 0.2 ml each were successfully delivered into ischemic noninfarcted myocardium pre-identified by single-photon emission computed tomography perfusion imaging.


RESULTS
Autologous bone marrow injection was successful in all patients and was associated with no serious adverse effects; in particular, there was no arrhythmia, evidence of infection, myocardial inflammation, or increased scar formation. Two patients were readmitted for recurrent chest pain. At three months, Canadian Cardiovascular Society angina score significantly improved (3.1 +/- 0.3 vs. 2.0 +/- 0.94, p = 0.001), as well as stress-induced ischemia occurring within the injected territories (2.1 +/- 0.8 vs. 1.6 +/- 0.8, p < 0.001). Treadmill exercise duration, available in nine patients, increased, but the change was not significant (391 +/- 155 vs. 485 +/- 198, p = 0.11).


CONCLUSIONS
This study provides preliminary clinical data indicating feasibility of catheter-based transendocardial delivery of ABM to ischemic myocardium.
Fuchs
Shmuel
S
Cardiovascular Research Institute, MedStar Research Institute, Washington Hospital Center, 110 Irving Street NW, 4B-1, Washington, DC 20010, USA. sfuchsel2002@yahoo.com
Satler
Lowell F
LF
Kornowski
Ran
R
Okubagzi
Petros
P
Weisz
Giora
G
Baffour
Richard
R
Waksman
Ron
R
Weissman
Neil J
NJ
Cerqueira
Manuel
M
Leon
Martin B
MB
Epstein
Stephen E
SE
D016026:Bone Marrow Transplantation; D002404:Catheterization; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D010865:Pilot Projects; D015899:Tomography, Emission-Computed, Single-Photon; D014182:Transplantation, Autologous