Percutaneous trans-coronary-venous transplantation of autologous skeletal myoblasts in the treatment of post-infarction myocardial contractility impairment: the POZNAN trial.
OBJECTIVE
Several experimental studies and the initial clinical experience have shown that autologous skeletal myoblast transplantation into the area of post-infarction left ventricular injury results in an increase in segmental contractile performance. This phase I clinical trial was designed to assess the feasibility and safety of autologous skeletal myoblast transplantation performed via a percutaneous trans-coronary-venous approach in patients with post-infarction left ventricular dysfunction.


RESULTS
Ten patients with heart failure and presence of an akinetic or a dyskinetic post-infarction injury with no viable myocardium were included in the study. Skeletal myoblasts were obtained from a biopsy specimen and grown in cell culture. Patients were treated with prophylactic amiodarone infusion before and during the procedure, except one patient. Skeletal myoblast transplantations were performed uneventfully in nine patients using the TransAccess catheter system under fluoroscopic and intravascular ultrasound guidance. In one patient, the procedure was not performed because of the inability of appropriate coronary sinus guiding wire positioning across venous valve. In five patients, the anterior interventricular vein and in four patients, the middle cardiac vein were used to access the myocardium. Two to four intramyocardial injections 1.5-4.5 cm deep were performed in each patient, delivering up to 100 million cells in 0.4-2.5 mL of saline. During 6 months follow-up, New York Heart Association class improved in all patients and ejection fraction increased 3-8% in six out of nine cases.


CONCLUSIONS
These data suggest the feasibility and procedural safety of myoblast transplantation performed via the trans-coronary-venous approach using the TransAccess catheter system.
Siminiak
Tomasz
T
University School of Medical Sciences, Department of Cardiology, District Hospital, ul. Juraszow 7/19, PL 60-479 Poznań, Poland. tomasz.siminiak@usoms.poznan.pl
Fiszer
Dorota
D
Jerzykowska
Olga
O
Grygielska
Beata
B
Rozwadowska
Natalia
N
Kałmucki
Piotr
P
Kurpisz
Maciej
M
D000328:Adult; D006328:Cardiac Catheterization / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D032448:Myoblasts, Skeletal / Q000637:transplantation*; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000150:complications*; D014182:Transplantation, Autologous; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000628:therapy*