title: The combined use of transmyocardial laser revascularisation and intramyocardial injection of bone-marrow derived stem cells in patients with end-stage coronary artery disease: one year follow-up.
abstract: BACKGROUND
  There are a growing number of patients with end-stage coronary artery disease (CAD) and refractory angina. Angiogenesis may be induced by intramyocardial injection of autologous bone marrow stem cells, intensified by inflammation around channels performed by laser.
  
  
  OBJECTIVE
  To assess the effect of a combined treatment consisting of transmyocardial laser revascularisation (TLMR) and intramyocardial injection of bone-marrow derived stem cells (bone marrow laser revascularisation, BMLR) in patients with refractory angina one year after the procedure.
  
  
  METHODS
  Five male patients (age 49-78 years) with end-stage diffuse CAD, severe angina (CCS III/IV) despite intensive medical therapy and disqualified from prior coronary artery bypass grafting (CABG) or percutaneous coronary intervention were included. After heart exposure, at sites where CABG was impossible, TMLR was performed with the Holmium: YAG laser combined with injection of 1 mL of bone marrow concentrate into the border zone of a laser channel using a Phoenix handpiece.
  
  
  RESULTS
  No deaths in the follow-up period were observed. All patients were in I CCS Class. One year after the procedure,left ventricular (LV) segments treated by BMLR tended to demonstrate stronger myocardial thickening compared to baseline(53.0 ± 7.5% vs. 45.0 ± 9.5%; p = 0.06). Using late gadolinium-enhanced imaging, new myocardial infarction was found after one year only in one LV segment treated by BMLR. The BMLR treated regions in the remaining subjects, as well as regions subtended by left internal thoracic artery in two subjects, did not show new myocardial infarction areas. In contrast,all subjects who underwent only BMLR procedure revealed new and/or more extensive myocardial infarct in regions not treated by BMLR.
  
  
  CONCLUSIONS
  Intramyocardial delivery of bone marrow stem-cells together with laser therapy is a safe procedure, with improvement in quality of life during follow-up. One year after the procedure, myocardial regions where BMLR was performed tended to demonstrate stronger myocardial thickening observed in cardiac magnetic resonance imaging.
authors.affiliation: Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland. jakonstanty@poczta.onet.pl
authors.forename: Janusz
authors.initials: J
authors.lastname: Konstanty-Kalandyk
authors.forename: Jacek
authors.initials: J
authors.lastname: Piątek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Miszalski-Jamka
authors.forename: Paweł
authors.initials: P
authors.lastname: Rudziński
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Walter
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bartuś
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Urbańczyk-Zawadzka
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sadowski
mesh_terms: D000368:Aged; D016026:Bone Marrow Transplantation; D003324:Coronary Artery Disease / Q000628:therapy*; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D011788:Quality of Life; D012008:Recurrence; D033581:Stem Cell Transplantation; D057769:Transmyocardial Laser Revascularization / Q000009:adverse effects; D016896:Treatment Outcome