title: Transmyocardial laser revascularization combined with intramyocardial endothelial progenitor cell transplantation in patients with intractable ischemic heart disease ineligible for conventional revascularization: preliminary results in a highly selected small patient cohort.
abstract: OBJECTIVE
  Transmyocardial laser revascularization for angina relief and intramyocardial autologous endothelial progenitor cell injection for neoangiogenesis may offer a new treatment strategy for patients with intractable ischemic heart disease.
  
  
  METHODS
  Transmyocardial laser revascularization and intramyocardial injection of bone marrow-derived CD133+ cells was performed in six highly symptomatic patients. Transmyocardial laser channels were created and isolated CD133+ cells were injected intramyocardially. All patients were followed up for a minimum of 6 months postoperatively.
  
  
  RESULTS
  One patient died shortly after the operation due to refractory heart failure. In the five survivors, CCS class improved as well as left ventricular ejection fraction. Left ventricular end-diastolic volume and myocardial perfusion varied between the patients. All patients described a considerable improvement in quality of life postoperatively. Repeated 24-hour Holter monitoring revealed no significant arrhythmias.
  
  
  CONCLUSIONS
  In this small patient cohort, intramyocardial CD 133+ cell injection combined with transmyocardial laser revascularization led to an improvement in clinical symptomatology in all patients and in left ventricular function in 4 out of 5 patients, with an unclear effect on myocardial perfusion. Caution is advised when employing this therapy in patients with severely depressed left ventricular function.
authors.affiliation: Cardiac and Thoracic Vascular Surgery Clinic, University of Luebeck, Luebeck, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Babin-Ebell
authors.forename: H-H
authors.initials: HH
authors.lastname: Sievers
authors.forename: E I
authors.initials: EI
authors.lastname: Charitos
authors.forename: H M
authors.initials: HM
authors.lastname: Klein
authors.forename: F
authors.initials: F
authors.lastname: Jung
authors.forename: A-K
authors.initials: AK
authors.lastname: Hellberg
authors.forename: R
authors.initials: R
authors.lastname: Depping
authors.forename: H A
authors.initials: HA
authors.lastname: Sier
authors.forename: J
authors.initials: J
authors.lastname: Marxsen
authors.forename: S
authors.initials: S
authors.lastname: Stoelting
authors.forename: E G
authors.initials: EG
authors.lastname: Kraatz
authors.forename: K F
authors.initials: KF
authors.lastname: Wagner
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D042783:Endothelial Cells / Q000637:transplantation*; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods*; D033581:Stem Cell Transplantation; D013234:Stem Cells; D016896:Treatment Outcome