Perin Emerson C, Silva Guilherme V, Fernandes Marlos R, Munger Torrey, Pandey Ashwini, Sehra Ruchir, Talcott Michael, Bichard Christopher J, Creed Jerett, Wong Jonathan W C, Oliveira Edie M, Zheng Yi, Canales John, Cardoso Cristiano O, Patterson Mark S, Serruys Patrick W
Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX, USA.
EuroIntervention. 2007 May;3(1):142-8.
The purpose of this preclinical feasibility study was to evaluate a novel integrated platform in which magnetic navigation is used to remotely guide electromechanical mapping of the left ventricle (LV) and transendocardial cell injections. Using an integrated remote system would greatly facilitate intramyocardial delivery of stem cells for treating ischaemic heart disease.
We used the computer-controlled Stereotaxis magnetic navigation system to guide the NOGA electromechanical mapping system in mapping viable myocardium in the LV of seven pigs. We then tested the feasibility of this system to perform transendocardial injections in three of the pigs and to deliver mesenchymal precursor cells (MPCs) to targeted myocardial segments in four of the pigs. The success or failure of each injection was determined by myocardial contrast staining in the first group and by histopathologic analysis in the last group. The mean time (+/-SD) spent mapping the LV for each pig was 49.3+/-10.6 min. The success rate for transendocardial injections was 94.4%, as indicated by myocardial contrast staining. There was a 95.8% success rate for targeted injections of MPCs, and 4',6-diamidino-2-phenylindole-labeled MPCs were detected in all but one segment of one pig. No epicardial haemorrhage or injury was observed, although there was some venous drainage.
The integrated Stereotaxis/NOGA system has excellent remote navigability inside the LV cavity while sparing the operator from radiation exposure. This system also allows transendocardial cell injections to be performed with a high success rate. Further studies are needed to define the safety profile of this system for clinical use.
本临床前可行性研究的目的是评估一种新型集成平台，该平台利用磁导航远程引导左心室（LV）的机电标测和经心内膜细胞注射。使用集成远程系统将极大地促进干细胞心肌内递送以治疗缺血性心脏病。
我们使用计算机控制的立体定向磁导航系统引导NOGA机电标测系统对7头猪的左心室存活心肌进行标测。然后，我们测试了该系统在3头猪中进行经心内膜注射以及在4头猪中将间充质前体细胞（MPC）递送至目标心肌节段的可行性。第一组通过心肌对比染色确定每次注射的成功或失败，最后一组通过组织病理学分析确定。每头猪标测左心室的平均时间（±标准差）为49.3±10.6分钟。心肌对比染色显示经心内膜注射的成功率为94.4%。MPC靶向注射的成功率为95.8%，除一头猪的一个节段外，在所有节段均检测到4',6-二脒基-2-苯基吲哚标记的MPC。尽管有一些静脉引流，但未观察到心包出血或损伤。
集成的立体定向/NOGA系统在左心室腔内具有出色的远程导航能力，同时使操作者免受辐射暴露。该系统还能以高成功率进行经心内膜细胞注射。需要进一步研究来确定该系统临床使用的安全性。
