Mid Term Results After Bone Marrow Laser Revascularization for Treating Refractory Angina

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2010 Sep 21

PMID 20849586

Citations 3

Authors

Guillermo Reyes

Keith B Allen

Pablo Alvarez

Adrian Alegre

Beatriz Aguado

MariaJose Olivera

Paloma Caballero

JoseLuis Rodriguez

Juan Duarte

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy.

Iwanski J, Wong R, Larson D, Ferng A, Runyan R, Goldstein S Springerplus. 2016; 5(1):738.

PMID: 27376006 PMC: 4909685. DOI: 10.1186/s40064-016-2355-6.

Transmyocardial revascularization devices: technology update.

Kindzelski B, Zhou Y, Horvath K Med Devices (Auckl). 2015; 8:11-9.

PMID: 25565905 PMC: 4274152. DOI: 10.2147/MDER.S51591.

Optimization of the cardiovascular therapeutic properties of mesenchymal stromal/stem cells-taking the next step.

Richardson J, Nelson A, Zannettino A, Gronthos S, Worthley S, Psaltis P Stem Cell Rev Rep. 2012; 9(3):281-302.

PMID: 22529015 DOI: 10.1007/s12015-012-9366-7.

References

Reyes G, Allen K, Aguado B, Duarte J . Bone marrow laser revascularisation for treating refractory angina due to diffuse coronary heart disease. Eur J Cardiothorac Surg. 2009; 36(1):192-4. DOI: 10.1016/j.ejcts.2009.03.022. View

Graham M, CHAMBERS R, Davies R . Angiographic quantification of diffuse coronary artery disease: reliability and prognostic value for bypass operations. J Thorac Cardiovasc Surg. 1999; 118(4):618-27. DOI: 10.1016/S0022-5223(99)70006-1. View

Aaberge L, Rootwelt K, Blomhoff S, Saatvedt K, Abdelnoor M, Forfang K . Continued symptomatic improvement three to five years after transmyocardial revascularization with CO(2) laser: a late clinical follow-up of the Norwegian Randomized trial with transmyocardial revascularization. J Am Coll Cardiol. 2002; 39(10):1588-93. DOI: 10.1016/s0735-1097(02)01828-4. View

Heidt M, Sedding D, Stracke S, Stadlbauer T, Boening A, Vogt P . Measurement of myocardial oxygen tension: a valid and sensitive method in the investigation of transmyocardial laser revascularization in an acute ischemia model. Thorac Cardiovasc Surg. 2009; 57(2):79-84. DOI: 10.1055/s-2008-1039209. View

Cheng D, Diegeler A, Allen K, Weisel R, Lutter G, Sartori M . Transmyocardial laser revascularization: a meta-analysis and systematic review of controlled trials. Innovations (Phila). 2012; 1(6):295-313. DOI: 10.1097/IMI.0b013e31802fe0a2. View

Pompilio G, Steinhoff G, Liebold A, Pesce M, Alamanni F, Capogrossi M . Direct minimally invasive intramyocardial injection of bone marrow-derived AC133+ stem cells in patients with refractory ischemia: preliminary results. Thorac Cardiovasc Surg. 2008; 56(2):71-6. DOI: 10.1055/s-2007-989351. View

Gowdak L, Schettert I, Rochitte C, Lisboa L, Dallan L, Cesar L . Cell therapy plus transmyocardial laser revascularization for refractory angina. Ann Thorac Surg. 2005; 80(2):712-4. DOI: 10.1016/j.athoracsur.2005.04.080. View

Hughes G, Kypson A, Annex B, Yin B, St Louis J, Biswas S . Induction of angiogenesis after TMR: a comparison of holmium: YAG, CO2, and excimer lasers. Ann Thorac Surg. 2000; 70(2):504-9. DOI: 10.1016/s0003-4975(00)01569-1. View

Allen K, Dowling R, Angell W, Gangahar D, Fudge T, Richenbacher W . Transmyocardial revascularization: 5-year follow-up of a prospective, randomized multicenter trial. Ann Thorac Surg. 2004; 77(4):1228-34. DOI: 10.1016/j.athoracsur.2004.01.008. View

10.

Weintraub W, Jones E, Craver J, Guyton R . Frequency of repeat coronary bypass or coronary angioplasty after coronary artery bypass surgery using saphenous venous grafts. Am J Cardiol. 1994; 73(2):103-12. DOI: 10.1016/0002-9149(94)90198-8. View

11.

Hughes G, Biswas S, Yin B, Baklanov D, Annex B, Coleman R . A comparison of mechanical and laser transmyocardial revascularization for induction of angiogenesis and arteriogenesis in chronically ischemic myocardium. J Am Coll Cardiol. 2002; 39(7):1220-8. DOI: 10.1016/s0735-1097(02)01734-5. View

12.

Frazier O, March R, Horvath K . Transmyocardial revascularization with a carbon dioxide laser in patients with end-stage coronary artery disease. N Engl J Med. 1999; 341(14):1021-8. DOI: 10.1056/NEJM199909303411402. View

13.

Klein H, Ghodsizad A, Borowski A, Saleh A, Draganov J, Poll L . Autologous bone marrow-derived stem cell therapy in combination with TMLR. A novel therapeutic option for endstage coronary heart disease: report on 2 cases. Heart Surg Forum. 2005; 7(5):E416-9. DOI: 10.1532/HSF98.20041095. View

14.

Losordo D, Vale P, Symes J, Dunnington C, Esakof D, Maysky M . Gene therapy for myocardial angiogenesis: initial clinical results with direct myocardial injection of phVEGF165 as sole therapy for myocardial ischemia. Circulation. 1998; 98(25):2800-4. DOI: 10.1161/01.cir.98.25.2800. View

15.

Allen K, Dowling R, Fudge T, Schoettle G, Selinger S, Gangahar D . Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med. 1999; 341(14):1029-36. DOI: 10.1056/NEJM199909303411403. View

16.

Patel A, Spadaccio C, Kuzman M, Park E, Fischer D, Stice S . Improved cell survival in infarcted myocardium using a novel combination transmyocardial laser and cell delivery system. Cell Transplant. 2008; 16(9):899-905. DOI: 10.3727/096368907783338253. View

17.

Losordo D, Schatz R, White C, Udelson J, Veereshwarayya V, Durgin M . Intramyocardial transplantation of autologous CD34+ stem cells for intractable angina: a phase I/IIa double-blind, randomized controlled trial. Circulation. 2007; 115(25):3165-72. DOI: 10.1161/CIRCULATIONAHA.106.687376. View

18.

Abdel-Latif A, Bolli R, Tleyjeh I, Montori V, Perin E, Hornung C . Adult bone marrow-derived cells for cardiac repair: a systematic review and meta-analysis. Arch Intern Med. 2007; 167(10):989-97. DOI: 10.1001/archinte.167.10.989. View

19.

Horvath K, Chiu E, Maun D, Lomasney J, Greene R, Pearce W . Up-regulation of vascular endothelial growth factor mRNA and angiogenesis after transmyocardial laser revascularization. Ann Thorac Surg. 1999; 68(3):825-9. DOI: 10.1016/s0003-4975(99)00842-5. View

20.

Lutter G, Attmann T, Heilmann C, von Samson P, von Specht B, Beyersdorf F . The combined use of transmyocardial laser revascularization (TMLR) and fibroblastic growth factor (FGF-2) enhances perfusion and regional contractility in chronically ischemic porcine hearts. Eur J Cardiothorac Surg. 2002; 22(5):753-61. DOI: 10.1016/s1010-7940(02)00527-4. View