Department of Cardiovascular Surgery, Hospital Universitario La Princesa, Madrid 28006, Spain.
BMC Cardiovasc Disord. 2010 Sep 17;10:42. doi: 10.1186/1471-2261-10-42.
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.
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.
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.
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.
评估联合应用心肌内移植和自体干细胞治疗心绞痛和弥漫性冠状动脉疾病患者的中期结果。
2007 年 6 月至 2009 年 12 月，对 19 例弥漫性冠状动脉疾病和药物难治性 III/IV 级心绞痛患者进行单独 TMR 联合心肌内注射浓缩干细胞治疗的疗效评估。手术时从髂嵴抽吸自体骨髓（120cc）。术前和术后均进行心脏 MRI 和同位素检查。通过个人访谈进行随访。
无围手术期不良事件，包括无心律失常。平均激光通道数为 20 个，每毫升心肌内注射的细胞总数为：总单个核细胞（83.6×10^6）、CD34+细胞（0.6×10^6）和 CD133+细胞（0.34×10^6）。12 个月平均随访时，平均心绞痛分级显著改善（3.4±0.5 比 1.4±0.6；p=0.004）。此外，每月心血管药物使用量显著减少（348±118 比 201±92；p=0.001）。在 6 个月随访时，心脏住院再入院次数减少（2.9±2.3 比 0.5±0.8；p<0.001）。MRI 显示 LV 容积无变化，射血分数提高 3%。
干细胞分离器有效地浓缩了自体骨髓源性干细胞，而 TMR/干细胞联合输送装置则顺利运行。在中期随访中观察到临床状况的改善。图像检查显示手术后左心室形态无改变。
