Mid term results after bone marrow laser revascularization for treating refractory angina.
BACKGROUND
To evaluate the midterm results of patients with angina and diffuse coronary artery disease treated with transmyocardial revascularization in combination with autologous stem cell therapy.


METHODS
Nineteen patients with diffuse coronary artery disease and medically refractory class III/IV angina were evaluated between June 2007 and December 2009 for sole therapy TMR combined with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120cc) was aspirated from the iliac crest. A cardiac MRI and an isotopic test were performed before and after the procedure. Follow-up was performed by personal interview.


RESULTS
There were no perioperative adverse events including no arrhythmias. Mean number of laser channels was 20 and the mean total number of intramyocardially injected cells per milliliter were: total mononuclear cells(83.6 × 10(6)), CD34+ cells(0.6 × 10(6)), and CD133+ cells(0.34 × 10(6)). At 12 months mean follow-up average angina class was significantly improved (3.4 ± 0.5 vs 1.4 ± 0.6; p = 0.004). In addition, monthly cardiovascular medication usage was significantly decreased (348 ± 118 vs. 201 ± 92; p = 0.001). At six months follow up there was a reduction in the number of cardiac hospital readmissions (2.9 ± 2.3 vs. 0.5 ± 0.8; p < 0.001). MRI showed no alterations regarding LV volumes and a 3% improvement regarding ejection fraction.


CONCLUSIONS
The stem cell isolator efficiently concentrated autologous bone marrow derived stem cells while the TMR/stem cell combination delivery device worked uneventfully. An improvement in clinical status was noticed in the midterm follow-up. Images test showed no morphological alterations in the left ventricle after the procedure.
Reyes
Guillermo
G
Department of Cardiovascular Surgery, Hospital Universitario La Princesa, Madrid 28006, Spain. guillermo_reyes_copa@yahoo.es
Allen
Keith B
KB
Alvarez
Pablo
P
Alegre
Adrian
A
Aguado
Beatriz
B
Olivera
MariaJose
M
Caballero
Paloma
P
Rodríguez
JoseLuis
J
Duarte
Juan
J
D000368:Aged; D000789:Angina, Unstable; D001853:Bone Marrow / Q000473:pathology; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation; D057769:Transmyocardial Laser Revascularization; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014336:Troponin / Q000378:metabolism
D014336:Troponin; D052279:Creatine Kinase, MB Form