Department of Cardiovascular Surgery of the First Affiliated Hospital & Institute for Cardiovascular Science, Soochow University, Suzhou, People's Republic of China.
Cell Transplant. 2023 Jan-Dec;32:9636897231152381. doi: 10.1177/09636897231152381.
Bone marrow stem cell (BMSC) transplantation during coronary artery bypass graft (CABG) is an innovative treatment for ischemic heart disease (IHD). We conduct a meta-analysis to examine whether patients with IHD presenting heart failure with reduced ejection fraction (HFrEF) can be beneficent from CABG with additional BMSC transplantation. Electronic searches were performed on PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov from their inception to July 2021. The efficacy was based on left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and 6-min walk test (6MWT) change after treatment. Eight randomized-controlled trials (RCTs) were included in this meta-analysis, with a total of 350 patients. Results showed BMSC transplantation significantly improved the LVEF [mean difference (MD) = 6.23%, 95% confidence interval (CI): 3.22%-9.24%, < 0.0001], LVEDVi (MD = -20.15 ml/m, 95% CI: -30.49 to -9.82 ml/m, < 0.00001), and LVESVi (MD = -17.69 ml/m, 95% CI: -25.24 to -10.14 ml/m, < 0.00001). There was no statistically significant difference in the improvement of LVEDD, LVEDV, and 6MWT between the cell transplantation group and control groups. Subgroup analysis revealed that the intervention for control group could affect the efficacy of BMSC transplantation. Sensitivity analysis found the conclusion of LVEDD, LVEDV, and 6MWT changes was not stable. Therefore, among patients with IHD presenting HFrEF, BMSC transplantation during CABG is promising to be beneficial for postoperative left ventricular (LV) function improvement. However, according to the unstable results of the sensitivity analysis, it cannot be concluded whether the extra step has a positive effect on left ventricular remodeling and exercise capacity. RCTs with larger cohorts and more strict protocols are needed to validate these conclusions.
骨髓间充质干细胞（BMSC）移植术在冠状动脉旁路移植术（CABG）中的应用是缺血性心脏病（IHD）的一种创新治疗方法。我们进行了一项荟萃分析，以检验是否患有射血分数降低的心力衰竭（HFrEF）的 IHD 患者可从 CABG 联合 BMSC 移植中获益。我们在 PubMed、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov 上进行了电子检索，检索时间从建库至 2021 年 7 月。疗效以左心室射血分数（LVEF）、左心室舒张末期直径（LVEDD）、左心室舒张末期容积（LVEDV）、左心室舒张末期容积指数（LVEDVi）、左心室收缩末期容积指数（LVESVi）和治疗后 6 分钟步行试验（6MWT）的变化为基础。本荟萃分析纳入了 8 项随机对照试验（RCT），共 350 例患者。结果显示，BMSC 移植可显著改善 LVEF [平均差值（MD）=6.23%，95%置信区间（CI）：3.22%-9.24%，<0.0001]、LVEDVi（MD=-20.15ml/m，95%CI：-30.49 至-9.82ml/m，<0.00001）和 LVESVi（MD=-17.69ml/m，95%CI：-25.24 至-10.14ml/m，<0.00001）。细胞移植组与对照组在 LVEDD、LVEDV 和 6MWT 改善方面的差异无统计学意义。亚组分析显示，对照组的干预措施可能会影响 BMSC 移植的疗效。敏感性分析发现 LVEDD、LVEDV 和 6MWT 变化的结论不稳定。因此，在患有 HFrEF 的 IHD 患者中，CABG 期间的 BMSC 移植有望有益于术后左心室（LV）功能的改善。然而，根据敏感性分析不稳定的结果，尚不能确定这一额外步骤是否对左心室重构和运动能力有积极影响。需要进行更大规模队列和更严格方案的 RCT 来验证这些结论。
