Percutaneous transvenous cellular cardiomyoplasty. A novel nonsurgical approach for myocardial cell transplantation.
OBJECTIVE
The study evaluated a nonsurgical means of intramyocardial cell introduction using the coronary venous system for direct myocardial access and cell delivery.


BACKGROUND
Direct myocardial cell repopulation has been proposed as a potential method to treat heart failure.


METHODS
We harvested bone marrow from Yorkshire swine (n = 6; 50 to 60 kg), selected culture-flask adherent cells, labeled them with the gene for green fluorescence protein, expanded them in culture, and resuspended them in a collagen hydrogel. Working through the coronary sinus, a specialized catheter system was easily delivered to the anterior interventricular coronary vein. The composite catheter system (TransAccess) incorporates a phased-array ultrasound tip for guidance and a sheathed, extendable nitinol needle for transvascular myocardial access. A microinfusion (IntraLume) catheter was advanced through the needle, deep into remote myocardium, and the autologous cell-hydrogel suspension was injected into normal heart. Animals were sacrificed at days 0 (n = 2), 14 (n = 1, + 1 control/collagen biogel only), and 28 (n = 2), and the hearts were excised and examined.


RESULTS
We gained widespread intramyocardial access to the anterior, lateral, septal, apical, and inferior walls from the anterior interventicular coronary vein. No death, cardiac tamponade, ventricular arrhythmia, or other procedural complications occurred. Gross inspection demonstrated no evidence of myocardial perforation, and biogel/black tissue dye was well localized to sites corresponding to fluoroscopic landmarks for delivery. Histologic analysis demonstrated needle and microcatheter tracts and accurate cell-biogel delivery.


CONCLUSIONS
Percutaneous intramyocardial access is safe and feasible by a transvenous approach through the coronary venous system. The swine offers an opportunity to refine approaches used for cellular cardiomyoplasty.
Thompson
Craig A
CA
Cardiovascular Division, Knight Center for Cardiac Catheterization and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Blake 950, Boston, MA 02114, USA. cathompson@partners.org
Nasseri
Boris A
BA
Makower
Joshua
J
Houser
Stuart
S
McGarry
Michael
M
Lamson
Theodore
T
Pomerantseva
Irina
I
Chang
John Y
JY
Gold
Herman K
HK
Vacanti
Joseph P
JP
Oesterle
Stephen N
SN
D000818:Animals; D018421:Cardiomyoplasty; D002469:Cell Separation; D017690:Cell Transplantation; D003331:Coronary Vessels / Q000166:cytology; D005240:Feasibility Studies; D005434:Flow Cytometry; D005500:Follow-Up Studies; D049452:Green Fluorescent Proteins; D006346:Heart Septum / Q000166:cytology / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000166:cytology / Q000000981:diagnostic imaging; D007150:Immunohistochemistry; D007202:Indicators and Reagents / Q000378:metabolism; D007273:Injections, Intramuscular; D008164:Luminescent Proteins / Q000096:biosynthesis; D008856:Microscopy, Fluorescence; D023421:Models, Animal; D008955:Models, Cardiovascular; D009206:Myocardium / Q000166:cytology* / Q000378:metabolism; D032383:Myocytes, Cardiac / Q000000981:diagnostic imaging / Q000378:metabolism / Q000637:transplantation*; D011859:Radiography; D013552:Swine; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D007202:Indicators and Reagents; D008164:Luminescent Proteins; D049452:Green Fluorescent Proteins