title: Five-year follow-up after transepicardial implantation of autologous bone marrow mononuclear cells to ungraftable coronary territories for patients with ischaemic cardiomyopathy.
abstract: OBJECTIVE
  Cell therapy for patients with ischaemic cardiomyopathy (IC) is still an open issue. We aimed to assess the long-term safety and therapeutic potency of autologous bone marrow mononuclear cell (ABMMNC) implantation into ungraftable coronary artery (UCA) territories in patients with IC.
  
  
  METHODS
  Bone marrow was aspirated from the iliac crest, and transepicardial ABMMNC implantation (n=25, 24 men, aged 57+/-7 years) as an adjunct to coronary artery bypass grafting (CABG) was performed into an area of reversible ischaemia within the territory of UCA (1.29+/-0.09 x 10(9) ABMMNCs). Control group (n=25, 23 men, aged 59+/-7 years) underwent incomplete CABG due to poor target vessel graftability. The study protocol consisted of coronary angiography, stress echocardiography, nuclear imaging and Holter monitoring at baseline and follow-up. The mean follow-up time was 988+/-423 days.
  
  
  RESULTS
  There was no difference between the groups regarding postoperative complications and outcome. Overall 5-year survival for the ABMMNC group was 79+/-10%, and 71+/-12% for the controls (p=0.48). Left ventricular ejection fraction (LVEF) at baseline was 24.8+/-3.7 versus 25.9+/-3.1 in the ABMMNC group and the controls, respectively. After 6 months, mean global LVEF increased to 36.3+/-7.4 (p<0.001) versus 31.4+/-4.1 (p=0.001), respectively. A significant difference was noted in delta LVEF between the groups (p<0.001, 95% confidence interval (CI): 3.4-8.9) at 6 months, and (p=0.001, 95% CI: 2.0-7.4) at 1 year. Accordingly, perfusion scores in UCA segments detected by single-photon emission computed tomography (SPECT) improved with ABMMNC therapy to 18.0+/-24.4 from 7.1+/-25.7 (p=0.001 vs control UCA segments).
  
  
  CONCLUSIONS
  Cellular therapy for IC within UCA could augment myocardial perfusion and contractility but does not improve overall survival. No adverse events were detected after cell therapy at mid-term follow-up.
authors.affiliation: Department of Cardiovascular Surgery, Ankara University School of Medicine, Ankara, Turkey. akarruchan@gmail.com
authors.forename: Ahmet Ruchan
authors.initials: AR
authors.lastname: Akar
authors.forename: Serkan
authors.initials: S
authors.lastname: Durdu
authors.forename: Mutlu
authors.initials: M
authors.lastname: Arat
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kilickap
authors.forename: Nuriye Ozlem
authors.initials: NO
authors.lastname: Kucuk
authors.forename: Onder
authors.initials: O
authors.lastname: Arslan
authors.forename: Isinsu
authors.initials: I
authors.lastname: Kuzu
authors.forename: Umit
authors.initials: U
authors.lastname: Ozyurda
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass; D003326:Coronary Circulation / Q000502:physiology; D015716:Electrocardiography, Ambulatory; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome