Elsevier

American Heart Journal

Volume 151, Issue 1, January 2006, Pages 192-197
American Heart Journal

Clinical Investigation
Surgery
Autologous bone marrow mononuclear cell transplantation in patients undergoing coronary artery bypass grafting

https://doi.org/10.1016/j.ahj.2005.02.001Get rights and content

Background

Recent studies have shown that autologous bone marrow mononuclear cell (aBM-MNC) transplantation can be effectively performed in human beings either by the coronary route or by endoventricular injections. However, scanty data are available for patients undergoing coronary artery bypass grafting (CABG). Accordingly, the aim of this study was to evaluate the feasibility and safety of aBM-MNC transplantation in patients with recent myocardial infarction undergoing CABG.

Methods and Results

The study population included 36 consecutive patients with recent myocardial infarction (<6 months) undergoing CABG. Eighteen patients (17 men, mean age 64 years) underwent CABG plus aBM-MNC transplantation, whereas 18 subjects undergoing conventional CABG (17 men, mean age 67 years) served as control subjects. Cell transplantation was performed by direct injections in the border zone of the recently infarcted area. An average number of 292 ± 232 × 106 aBM-MNCs was injected in each patient. When compared with control subjects, transplanted patients showed higher values of troponin I peak after CABG (median values of 1.65 ng/mL vs 0.64 ng/mL, P < .001). No major transplant-related adverse event could be detected. During follow-up, transplanted patients had an improvement in left ventricular ejection fraction (from 0.46 to 0.51, P < .05) and wall motion score index (from 1.71 to 1.42, P < .01). The incidence of arrhythmias immediately after CABG and during follow-up was similar in the 2 groups.

Conclusions

Our data support the idea that direct injection of aBM-MNCs in the myocardium during CABG is feasible and safe. Larger studies are needed to assess the efficacy of such an approach in patients undergoing CABG.

Section snippets

Selection criteria

All patients undergoing CABG at our institution were prospectively screened for inclusion in the investigation. Consecutive patients with the following characteristics were selected for inclusion in the study:

  • 1.

    recent MI (>4 weeks but <6 months);

  • 2.

    planned CABG for at least 2 vessels,

  • 3.

    no evidence of myocardial viability in the infarct area, as shown by a preoperative low-dose dobutamine echocardiography.

Patients were excluded in the following instances:

  • 1.

    age >80 years;

  • 2.

    left ventricular ejection fraction

Results

Baseline clinical features of the study population are shown in Table I.

Patients with inferior or posterior MI did not undergo revascularization of the infarct-related vessel, whereas patients with anterior or apical MI did.

Discussion

It has been accepted for a long time that cardiac cell death results in an irreparable damage to the structure of the adult heart. However, recent research has challenged the dogmatic notion that the heart represents a terminally differentiated postmitotic organ incapable of self-renewal.21 As a matter of fact, both preclinical studies in animal models and preliminary clinical investigations have suggested that stem cell therapy may promote cardiac angiogenesis and cell regeneration, thereby

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