title: Preoperative mobilization of bone marrow-derived cells followed by revascularization surgery: early and long-term outcome.
abstract: BACKGROUND
  Coronary artery disease (CAD), along with its main complications such as acute myocardial infarction (AMI) and congestive heart failure (CHF), remains a serious worldwide problem and affects many patients despite the improvement of medical treatment. The possibility of the replacement of the infarcted areas by the re-generation of the myocardial cells has been long discussed and the mobilization of the stem cells from bone marrow (BMCs) to the peripheral blood (PB) induced by cytokines, represents a potential pathway to activate the regenerative process.
  
  
  METHODS
  We describe BMC mobilization and direct/indirect revascularization in 15 patients operated on for coronary artery bypass grafting (CABG) and/or mitral valve surgery and/or ventricular remodeling combined to multiple trans-myocardial punctures (Sen technique) in ungraftable non-viable fibrotic areas.
  
  
  RESULTS
  Peak values of circulating BMCs were recorded between day +4 and day +6. We had no in-hospital (0-30 days) mortality. All the patients were discharged from the ICU after a median period of 2 days while the in-hospital length of stay was 10.5+4.2 days (range 7-21) and all patients were discharged in good clinical condition. There were two sudden deaths over the mid-term, at postoperative day (POD) 32 and 45 respectively.
  
  
  CONCLUSIONS
  Our study suggests that the combination of BMC mobilization and CABG may be safely performed. However, considering the small series, final conclusions about the benefit of this procedure must await a larger prospective study comparing the role of cytokines alone, myocardial perforation, and the combination of both.
authors.affiliation: Division of Cardiac Surgery, Mauriziano Umberto I Hospital of Turin, Turin, Italy.
authors.forename: Guglielmo Mario Actis
authors.initials: GM
authors.lastname: Dato
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sansone
authors.forename: Paola
authors.initials: P
authors.lastname: Omedé
authors.forename: Edoardo
authors.initials: E
authors.lastname: Zingarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Flocco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Punta
authors.forename: Francesco
authors.initials: F
authors.lastname: Parisi
authors.forename: Pier Giuseppe
authors.initials: PG
authors.lastname: Forsennati
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Bardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Ponte
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casabona
authors.forename: Corrado
authors.initials: C
authors.lastname: Tarella
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000187:drug effects*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D005355:Fibrosis; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage*; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019650:Hematopoietic Stem Cell Mobilization / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007279:Injections, Subcutaneous; D007558:Italy; D007902:Length of Stay; D000078224:Lenograstim; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009206:Myocardium / Q000473:pathology*; D010865:Pilot Projects; D011300:Preoperative Care; D011446:Prospective Studies; D011677:Punctures; D011994:Recombinant Proteins / Q000008:administration & dosage; D018570:Risk Assessment; D013234:Stem Cells / Q000187:drug effects*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000078224:Lenograstim; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; C082430:molgramostim