Transmyocardial Laser Revascularization Combined with Intramyocardial Endothelial Progenitor Cell Transplantation in Patients with Intractable Ischemic Heart Disease Ineligible for Conventional Revascularization: Preliminary Results in a Highly Selected Small Patient Cohort

J. Babin-Ebell; H.-H. Sievers; E. I. Charitos; H. M. Klein; F. Jung; A.-K. Hellberg; R. Depping; H. A. Sier; J. Marxsen; S. Stoelting; E. G. Kraatz; K. F. Wagner

doi:10.1055/s-0029-1186199

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2010; 58(1): 11-16
DOI: 10.1055/s-0029-1186199

Original Cardiovascular

Transmyocardial Laser Revascularization Combined with Intramyocardial Endothelial Progenitor Cell Transplantation in Patients with Intractable Ischemic Heart Disease Ineligible for Conventional Revascularization: Preliminary Results in a Highly Selected Small Patient Cohort

J. Babin-Ebell¹ , H.-H. Sievers¹ , E. I. Charitos¹ , H. M. Klein² , F. Jung³ , A.-K. Hellberg³ , R. Depping⁴ , H. A. Sier¹ , J. Marxsen⁵ , S. Stoelting⁵ , E. G. Kraatz¹ , K. F. Wagner⁶

¹Cardiac and Thoracic Vascular Surgery Clinic, University of Luebeck, Luebeck, Germany
²Cardiac Surgery Clinic, University of Düsseldorf, Düsseldorf, Germany
³Anesthesiology Clinic, University of Luebeck, Luebeck, Germany
⁴Department of Physiology, University of Luebeck, Luebeck, Germany
⁵Hematology and Oncology Clinic, University of Luebeck, Luebeck, Germany
⁶Anesthesiology Clinic (KFW), Suedstadt Clinic Rostock, Rostock, Germany

Abstract

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Abstract

Objective: Transmyocardial laser revascularization for angina relief and intramyocardial autologous endothelial progenitor cell injection for neoangiogenesis may offer a new treatment strategy for patients with intractable ischemic heart disease. Methods: Transmyocardial laser revascularization and intramyocardial injection of bone marrow-derived CD133+ cells was performed in six highly symptomatic patients. Transmyocardial laser channels were created and isolated CD133+ cells were injected intramyocardially. All patients were followed up for a minimum of 6 months postoperatively. Results: One patient died shortly after the operation due to refractory heart failure. In the five survivors, CCS class improved as well as left ventricular ejection fraction. Left ventricular end-diastolic volume and myocardial perfusion varied between the patients. All patients described a considerable improvement in quality of life postoperatively. Repeated 24-hour Holter monitoring revealed no significant arrhythmias. Conclusions: In this small patient cohort, intramyocardial CD 133+ cell injection combined with transmyocardial laser revascularization led to an improvement in clinical symptomatology in all patients and in left ventricular function in 4 out of 5 patients, with an unclear effect on myocardial perfusion. Caution is advised when employing this therapy in patients with severely depressed left ventricular function.

Key words

heart disease - cardiomyopathy - myocardial infarction

Full Text

References

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MD Efstratios I. Charitos

Cardiac and Thoracic Vascular Surgery Clinic
University of Lübeck

Ratzeburger Allee 160

23538 Lübeck

Germany

Phone: + 49 45 15 00 47 63

Fax: + 49 45 15 00 20 51

Email: efstratios.charitos@gmail.com