Randomized, controlled trial of intramuscular or intracoronary injection of autologous bone marrow cells into scarred myocardium during CABG versus CABG alone.
BACKGROUND
Studies of the transplantation of autologous bone marrow cells (BMCs) in patients with chronic ischemic heart disease have assessed effects on viable, peri-infarct tissue. We conducted a single-blinded, randomized, controlled study to investigate whether intramuscular or intracoronary administration of BMCs into nonviable scarred myocardium during CABG improves contractile function of scar segments compared with CABG alone.


METHODS
Elective CABG patients (n = 63), with established myocardial scars diagnosed as akinetic or dyskinetic segments by dobutamine stress echocardiography and confirmed at surgery, were randomly assigned CABG alone (control) or CABG with intramuscular or intracoronary administration of BMCs. The BMCs, which were obtained at the time of surgery, were injected into the mid-depth of the scar in the intramuscular group or via the graft conduit supplying the scar in the intracoronary group. Contractile function was assessed in scar segments by dobutamine stress echocardiography before and 6 months after treatment.


RESULTS
The proportion of patients showing improved wall motion in at least one scar segment after BMC treatment was not different to that observed in the control group (P = 0.092). Quantitatively, systolic fractional thickening in scar segments did not improve with BMC administration. Furthermore, BMCs did not improve scar transmurality, infarct volume, left ventricular volume, or ejection fraction.


CONCLUSIONS
Injection of autologous BMCs directly into the scar or into the artery supplying the scar is safe but does not improve contractility of nonviable scarred myocardium, reduce scar size, or improve left ventricular function more than CABG alone.
Ang
Keng-Leong
KL
Cardiac Surgery Unit, Department of Cardiovascular Science, University of Leicester, UK.
Chin
Derek
D
Leyva
Francisco
F
Foley
Paul
P
Kubal
Chandrashekhar
C
Chalil
Shajil
S
Srinivasan
Lakshmi
L
Bernhardt
Lizelle
L
Stevens
Suzanne
S
Shenje
Lincoln T
LT
Galiñanes
Manuel
M
D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D001026:Coronary Artery Bypass; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D016037:Single-Blind Method; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016277:Ventricular Function, Left