Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion.
We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.
Department of Cardiothoracic Surgery, AHEPA Hospital, Thessaloniki, Greece.
Kyriakos
K
Anastasiadis
Polychronis
P
Antonitsis
Helena
H
Argiriadou
Georgios
G
Koliakos
Argyrios
A
Doumas
Andre
A
Khayat
Christos
C
Papakonstantinou
Stephen
S
Westaby
D016026:Bone Marrow Transplantation / Q000379:methods*; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D006333:Heart Failure / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006353:Heart-Assist Devices / Q000639:trends; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery / Q000628:therapy*; D015425:Myocardial Reperfusion; D014182:Transplantation, Autologous; D015854:Up-Regulation
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