Holinski Sebastian, Schmeck Birte, Claus Benjamin, Radtke Hartmut, Elgeti Thomas, Holzhausen Martin, Konertz Wolfgang
Department of Cardiovascular Surgery, Charite, Humboldt University, Berlin, Germany.
Ann Thorac Cardiovasc Surg. 2011;17(4):383-9. doi: 10.5761/atcs.oa.10.01552.
Chronic heart failure after myocardial infarction is still a serious problem without a fundamental therapy. Experimental transplantation of bone marrow cells (BMC) into infarcted myocardium resulted in regeneration and functional improvement.
Clinical investigation of safety and efficacy of intracardiac transplantation of unselected autologous BMC.
22 patients scheduled for elective and isolated coronary artery bypass grafting (CABG) with a reduced LVEF due to myocardial infarction were included. Intraoperatively, sternal bone marrow blood was aspirated, and a sterile buffy coat was prepared and applicated. 19 age, LVEF and coronary disease matched patients served as controls. Heart function, geometry, and scar proportion were assessed by echocardiography and Gadolinium-MRI at the time of the operation and 6 months thereafter.
Transplanted patients received a mean number of 360 × 10⁶ BMC. We did not notice any significant differences in early or late complications in the transplant group as compared to controls. At six months follow up only the transplanted patients showed a significant improvement of NYHA classes from 2.7 to 1.5 and of LVEF from 36 to 43 %, (p < 0.05). Furthermore, only CABG concomitant with BMC-TX led to a significant reduction of left ventricular end diastolic diameter (LVEDD) from 59 to 54 mm and of scar proportion of the infarcted segments from 2.53 to 2.42, (p < 0.05).
Intracardiac transplantation of unselected, autologous BMC is safe and feasible. In adjunct with coronary revascularization it leads to an improvement of ventricular geometry and function. Moreover, it reduces myocardial scar proportion and heart failure symptoms.
心肌梗死后的慢性心力衰竭仍然是一个严重问题，尚无根本性治疗方法。将骨髓细胞（BMC）实验性移植到梗死心肌中可实现心肌再生并改善功能。
对未经选择的自体BMC心内移植的安全性和有效性进行临床研究。
纳入22例因心肌梗死导致左心室射血分数（LVEF）降低而计划进行择期单纯冠状动脉旁路移植术（CABG）的患者。术中抽取胸骨骨髓血，制备并应用无菌血沉棕黄层。19例年龄、LVEF和冠心病相匹配的患者作为对照。在手术时及术后6个月通过超声心动图和钆增强磁共振成像（Gadolinium-MRI）评估心脏功能、心脏几何形态和瘢痕比例。
移植患者平均接受360×10⁶个BMC。与对照组相比，我们未发现移植组在早期或晚期并发症方面有任何显著差异。在6个月随访时，仅移植患者的纽约心脏协会（NYHA）心功能分级从2.7显著改善至1.5，LVEF从36%提高至43%，（p<0.05）。此外，仅CABG联合BMC移植导致左心室舒张末期内径（LVEDD）从59 mm显著减小至54 mm，梗死节段的瘢痕比例从2.53降至2.42，（p<0.05）。
未经选择的自体BMC心内移植安全可行。与冠状动脉血运重建术联合应用可改善心室几何形态和功能。此外，还可降低心肌瘢痕比例和心力衰竭症状。
