Transvenous intramyocardial cellular delivery increases retention in comparison to intracoronary delivery in a porcine model of acute myocardial infarction.
BACKGROUND
Clinical trials using intracoronary (IC) delivery of cells have addressed efficacy but the optimal delivery technique is unknown. Our study aimed to determine whether transvenous intramyocardial (TVIM) approach was advantageous for cellular retention in AMI.


METHODS
Domestic pigs (n = 4) underwent catheterization with coronary angiography and ventriculography prior to infarction and pre- and post-cells. Pigs underwent 90-minute balloon occlusion of the left anterior descending artery (LAD). After one week they were prepared for IC (n = 2) or TVIM (n = 2) delivery of bone marrow mononuclear cells (MNC) labeled with GFP. IC infusion used an over-the-wire catheter to engage the LAD and balloon inflation to prevent retrograde flow. Venography via the coronary sinus was used for TVIM delivery. The anterior interventricular vein was engaged with a guidewire allowing use of the TransAccess catheter that is outfitted with an ultrasound tip for visualization. Animals were sacrificed one hour after delivery and tissue was analyzed.


RESULTS
Procedures were performed without complication and monitoring was uneventful. 1 x 10(8) MNC were isolated from each bone marrow (BM) preparation and 1 x 10(7) MNC delivered. Ventriculography at one week revealed wall motion abnormalities consistent with an anterior AMI. TVIM and IC delivery revealed mean 452 cells per section and 235 cells per section on average, respectively, in the infarct zone (P = 0.01).


CONCLUSIONS
We have demonstrated that TVIM approach for cell delivery is feasible and safe. Moreover, this approach may provide an advantage over IC infusion in retention of the cellular product; however, larger studies will be necessary.
George
Jon C
JC
Cardiovascular Research Institute, Case Western Reserve University, Cleveland, OH, USA.
Goldberg
Jonathan
J
Joseph
Matthew
M
Abdulhameed
Nasreen
N
Crist
Joshua
J
Das
Hiranmoy
H
Pompili
Vincent J
VJ
D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000818:Animals; D016026:Bone Marrow Transplantation / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D004195:Disease Models, Animal; D005471:Fluoroscopy; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D012038:Regeneration; D033581:Stem Cell Transplantation / Q000379:methods*; D034421:Sus scrofa
D003287:Contrast Media