title: Catheter-based transendocardial delivery of autologous bone-marrow-derived mononuclear cells in patients listed for heart transplantation.
abstract: Growing evidence suggests that transplantation of autologous bone-marrow mononuclear cells (ABMMNCs) can improve the perfusion and contractile function of ischemic myocardium. This procedure could potentially benefit transplant candidates awaiting a donor heart. To study the safety and feasibility of ABMMNC injection, we performed a prospective, nonrandomized, open-label study in 5 heart transplant candidates with severe ischemic heart failure. Each patient underwent baseline single-photon emission computed tomography, a ramp treadmill protocol, 2-dimensional echocardiography, 24-hour Holter monitoring, and signal-averaged electrocardiography, which were repeated at 2 and 6 months. Transendocardial delivery of ABMMNCs was done with the aid of electromechanical mapping to identify viable myocardium. Each patient received 15 ABMMNC injections of 0.2 cc each. There were no deaths, significant arrhythmias, or other major complications. The ABMMNC injection reduced the amount of ischemic myocardium (not statistically significant). More important, exercise test results improved significantly. Myocardial volume oxygen consumption increased from 10.6 +/- 3 mL/kg/min (baseline) to 16.3 +/- 7 mL/kg/min (2 months) and 23 +/- 7 mL/kg/min (6 months) (P = 0.0091). In 4 of the 5 cases, this was such an improvement that the patients were no longer eligible for cardiac transplantation. In addition, metabolic equivalents improved from 3.03 +/- 0.66 (baseline) to 4.65 +/- 1.99 (2 months) and 6.5 +/- 2.0 (6 months) (P = 0.0092). In conclusion, ABMMNC injections were performed safely and resulted in improved exercise capacity. This technique may hold promise as an alternative to medical management in patients with severe ischemic heart failure who are ineligible for conventional revascularization.
authors.affiliation: The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
authors.forename: Guilherme V
authors.initials: GV
authors.lastname: Silva
authors.forename: Emerson C
authors.initials: EC
authors.lastname: Perin
authors.forename: Hans F R
authors.initials: HF
authors.lastname: Dohmann
authors.forename: Radovan
authors.initials: R
authors.lastname: Borojevic
authors.forename: Suzana A
authors.initials: SA
authors.lastname: Silva
authors.forename: Andre L S
authors.initials: AL
authors.lastname: Sousa
authors.forename: Joao A R
authors.initials: JA
authors.lastname: Assad
authors.forename: William K
authors.initials: WK
authors.lastname: Vaughn
authors.forename: Claudio T
authors.initials: CT
authors.lastname: Mesquita
authors.forename: Luciano
authors.initials: L
authors.lastname: Belém
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Hans J F
authors.initials: HJ
authors.lastname: Dohmann
authors.forename: Ellen
authors.initials: E
authors.lastname: Barroso do Amaral
authors.forename: Joaquim
authors.initials: J
authors.lastname: Coutinho
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Branco
authors.forename: Edie
authors.initials: E
authors.lastname: Oliveira
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
mesh_terms: D016026:Bone Marrow Transplantation / Q000295:instrumentation / Q000379:methods*; D006328:Cardiac Catheterization; D004699:Endocardium; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000637:transplantation*; D017202:Myocardial Ischemia / Q000150:complications*; D011446:Prospective Studies; D014182:Transplantation, Autologous; D014850:Waiting Lists