Antonitsis P, Anastasiadis K, Koliakos G, Vaitsopoulou C, Kouzi-Koliakou K, Doumas A, Argiriadou H, Tossios P
Cardiothoracic Department, AHEPA University Hospital, Thessaloniki, Greece.
Hippokratia. 2012 Oct;16(4):366-70.
Ischemic cardiomyopathy has the distinctiveness of irreversible myocardial damage with scar tissue formation and mainly impaired perfusion of the remaining viable myocardium. We present results of the first series of patients with severe ischemic cardiomyopathy managed in our institution with intramyocardial implantation of autologous bone marrow stem cells at the time of coronary artery bypass grafting. The aim is to evaluate feasibility and safety of the procedure in our institution.
Nine patients with severe ischemic cardiomyopathy scheduled for elective coronary artery bypass grafting were managed with concurrent intramyocardial autologous bone marrow stem cells injection in pre-defined viable peri-infarct areas that showed poor perfusion and could not be grafted. Detailed mapping of infracted and hibernating myocardial segments was performed in all patients with single photon emission computed tomography segmental analysis.
There was no perioperative 30-day mortality. Improvement was evident in left ventricular ejection fraction which was increased significantly from 31.3% preoperatively to 42.4%, 46.6% and 52.5% at 3, 6 and 12 months respectively. Postoperative thallium scintigraphy revealed increased perfusion in myocardial segments corresponding to areas of stem cell injection and a net reduction in the estimated infarct size at 6 and 12 months in 5/8 (62.5%) patients.
Preliminary data from this pilot study show that intramyocardial administration of bone marrow stem cells in patients undergoing coronary bypass grafting for ischemic cardiomyopathy is safe and associated with an improvement in left ventricular function and enhanced reperfusion of non-viable myocardial territories.
缺血性心肌病具有不可逆心肌损伤并形成瘢痕组织的特点，主要表现为剩余存活心肌灌注受损。我们展示了在我院接受治疗的首批严重缺血性心肌病患者的治疗结果，这些患者在冠状动脉搭桥手术时进行了自体骨髓干细胞心肌内植入。目的是评估该手术在我院的可行性和安全性。
9例计划接受择期冠状动脉搭桥手术的严重缺血性心肌病患者，在预先确定的梗死周边存活区域（这些区域灌注不良且无法进行搭桥）同时接受了自体骨髓干细胞心肌内注射。所有患者均通过单光子发射计算机断层扫描节段分析对梗死和冬眠心肌节段进行了详细定位。
围手术期30天内无死亡病例。左心室射血分数有明显改善，术前为31.3%，术后3个月、6个月和12个月分别显著提高至42.4%、46.6%和52.5%。术后铊闪烁显像显示，对应干细胞注射区域的心肌节段灌注增加，5/8（62.5%）的患者在6个月和12个月时估计梗死面积净减少。
这项初步研究的初步数据表明，对于因缺血性心肌病接受冠状动脉搭桥手术的患者，心肌内注射骨髓干细胞是安全的，并且与左心室功能改善及非存活心肌区域再灌注增强相关。
