Thorac Cardiovasc Surg 2008; 56(2): 71-76
DOI: 10.1055/s-2007-989351
Original Cardiovascular

© Georg Thieme Verlag KG Stuttgart · New York

Direct Minimally Invasive Intramyocardial Injection of Bone Marrow-Derived AC133+ Stem Cells in Patients with Refractory Ischemia: Preliminary Results

G. Pompilio1 , G. Steinhoff2 , A. Liebold2 , M. Pesce3 , F. Alamanni1 , M. C. Capogrossi4 , P. Biglioli1
  • 1Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
  • 2Cardiac Surgery, University of Rostock, Rostock, Germany
  • 3Laboratory of Vascular Biology and Gene Therapy, Centro Cardiologico Monzino IRCCS, Milan, Italy
  • 4Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy
Further Information

Publication History

received May 28, 2007

Publication Date:
18 February 2008 (online)

Abstract

Background: Bone marrow-derived stem cells (BMSC) may represent a viable option for patients with myocardial ischemia refractory to conventional treatments. Material and Methods: In 5 patients (4 males and 1 female, mean age 64 ± 8 years) with untreatable angina pectoris (Canadian Cardiovascular Society Class III/IV), myocardial segments with stress-induced ischemia as assessed by gated single-photon emission computed tomography were injected with 4 to 12 million CD133+ BMSC. Cells were injected into the myocardium (2 anterior, 2 lateral, 1 inferior wall) through minimally invasive approaches (left minithoracotomy [n = 4] and subdiaphragmatic approach [n = 1]). At baseline, at 6 months and at 1 year of follow-up, an exercise test, gated single-photon emission computed tomography (SPECT), 2-D echocardiography and coronary angiography were performed to assess exercise capacity, myocardial perfusion, LV function and coronary anatomy. Results: Intramyocardial injection of autologous CD133+ BMSC cells was safe. No early or long-term complications were observed. After an average of 3.8 weeks from cell inoculation, all patients experienced a significant improvement of CCS class (from 3.8 to 1.8 at 6 months) and serial SPECT documented improvements of rest and stress perfusion in the injected territories at 6 months from operation. In 3 cases, coronary angiography showed an increase in the collateral score of the target areas. Clinical improvements still persist unchanged in 4 out of 5 cases at a mean of 36.5 months postoperatively. Conclusions: After stand-alone BMSC transplantation for refractory myocardial ischemia, we observed long-term clinical and perfusion improvements in the absence of adverse events.

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Dr. MD, PhD Giulio Pompilio

Cardiovascular Surgery
Centro Cardiologico Monzino IRCCS

Via Parea 4

20138 Milan

Italy

Phone: + 39 2 58 00 25 62

Fax: + 39 2 58 01 11 94

Email: giulio.pompilio@ccfm.it

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