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DOI: 10.1055/s-0029-1186199
© Georg Thieme Verlag KG Stuttgart · New York
Transmyocardial Laser Revascularization Combined with Intramyocardial Endothelial Progenitor Cell Transplantation in Patients with Intractable Ischemic Heart Disease Ineligible for Conventional Revascularization: Preliminary Results in a Highly Selected Small Patient Cohort
Publication History
received Nov. 5, 2008
Publication Date:
13 January 2010 (online)
![](https://www.thieme-connect.de/media/thoracic/201001/lookinside/thumbnails/10.1055-s-0029-1186199-1.jpg)
Abstract
Objective: Transmyocardial laser revascularization for angina relief and intramyocardial autologous endothelial progenitor cell injection for neoangiogenesis may offer a new treatment strategy for patients with intractable ischemic heart disease. Methods: Transmyocardial laser revascularization and intramyocardial injection of bone marrow-derived CD133+ cells was performed in six highly symptomatic patients. Transmyocardial laser channels were created and isolated CD133+ cells were injected intramyocardially. All patients were followed up for a minimum of 6 months postoperatively. Results: One patient died shortly after the operation due to refractory heart failure. In the five survivors, CCS class improved as well as left ventricular ejection fraction. Left ventricular end-diastolic volume and myocardial perfusion varied between the patients. All patients described a considerable improvement in quality of life postoperatively. Repeated 24-hour Holter monitoring revealed no significant arrhythmias. Conclusions: In this small patient cohort, intramyocardial CD 133+ cell injection combined with transmyocardial laser revascularization led to an improvement in clinical symptomatology in all patients and in left ventricular function in 4 out of 5 patients, with an unclear effect on myocardial perfusion. Caution is advised when employing this therapy in patients with severely depressed left ventricular function.
Key words
heart disease - cardiomyopathy - myocardial infarction
References
- 1 Horvath K A. Mechanisms and results of transmyocardial laser revascularization. Cardiology. 2004; 101 (1–3) 37-47
- 2 Huikeshoven M, van der Sloot J A, Tukkie R, Beek J F. Transmyocardial laser revascularisation and other treatment modalities for angina pectoris. Lasers Med Sci. 2003; 18 (1) 2-11
- 3 Abbott J D, Huang Y, Liu D, Hickey R, Krause D S, Giordano F J. Stromal cell-derived factor-1 alpha plays a critical role in stem cell recruitment to the heart after myocardial infarction but is not sufficient to induce homing in the absence of injury. Circulation. 2004; 110 (21) 3300-3305
- 4 Patel A N, Geffner L, Vina R F, Saslavsky J, Urschel Jr H C, Kormos R et al. Surgical treatment for congestive heart failure with autologous adult stem cell transplantation: a prospective randomized study. J Thorac Cardiovasc Surg. 2005; 130 (6) 1631-1638
- 5 Stamm C, Kleine H D, Choi Y H, Dunkelmann S, Lauffs J A, Lorenzen B et al. Intramyocardial delivery of CD133+ bone marrow cells and coronary artery bypass grafting for chronic ischemic heart disease: safety and efficacy studies. J Thorac Cardiovasc Surg. 2007; 133 (3) 717-725
- 6 Ghodsizad A, Ruhparwar A, Marktanner R, Borowski A, Mohammad Hasani M R, Poll L et al. Autologous transplantation of CD133+ BM-derived stem cells as a therapeutic option for dilatative cardiomyopathy. Cytotherapy. 2006; 8 (3) 308-310
- 7 Klein H M, Ghodsizad A, Borowski A, Saleh A, Draganov J, Poll L et al. Autologous bone marrow-derived stem cell therapy in combination with TMLR. A novel therapeutic option for endstage coronary heart disease: report on 2 cases. Heart Surg Forum. 2004; 7 (5) E416-E419
- 8 Klein H M, Ghodsizad A, Marktanner R, Poll L, Voelkel T, Mohammad Hasani M R et al. Intramyocardial implantation of CD133+ stem cells improved cardiac function without bypass surgery. Heart Surg Forum. 2007; 10 (1) E66-E69
- 9 Eguchi M, Masuda H, Asahara T. Endothelial progenitor cells for postnatal vasculogenesis. Clin Exp Nephrol. 2007; 11 (1) 18-25
- 10 Lyngbaek S, Schneider M, Hansen J L, Sheikh S P. Cardiac regeneration by resident stem and progenitor cells in the adult heart. Basic Res Cardiol. 2007; 102 (2) 101-114
- 11 Schachinger V, Erbs S, Elsasser A, Haberbosch W, Hambrecht R, Holschermann H et al. Intracoronary bone marrow-derived progenitor cells in acute myocardial infarction. N Engl J Med. 2006; 355 (12) 1210-1221
- 12 Wollert K C, Drexler H. Clinical applications of stem cells for the heart. Circ Res. 2005; 96 (2) 151-163
- 13 Menasche P, Alfieri O, Janssens S, McKenna W, Reichenspurner H, Trinquart L et al. The myoblast autologous grafting in ischemic cardiomyopathy (MAGIC) trial: first randomized placebo-controlled study of myoblast transplantation. Circulation. 2008; 117 (9) 1189-1200
- 14 Mirotsou M, Zhang Z, Deb A, Zhang L, Gnecchi M, Noiseux N et al. Secreted frizzled related protein 2 (Sfrp2) is the key Akt-mesenchymal stem cell-released paracrine factor mediating myocardial survival and repair. Proc Natl Acad Sci USA. 2007; 104 (5) 1643-1648
- 15 Tang Y L, Zhao Q, Qin X, Shen L, Cheng L, Ge J et al. Paracrine action enhances the effects of autologous mesenchymal stem cell transplantation on vascular regeneration in rat model of myocardial infarction. Ann Thorac Surg. 2005; 80 (1) 229-236
- 16 Tossios P, Muller-Ehmsen J, Schmidt M, Scheid C, Unal N, Moka D et al. No evidence of myocardial restoration following transplantation of mononuclear bone marrow cells in coronary bypass grafting surgery patients based upon cardiac SPECT and 18F-PET. BMC Med Imaging. 2006; 6 7
- 17 Yaoita H, Takase S, Maruyama Y, Sato Y, Satokawa H, Hoshi N et al. Scintigraphic assessment of the effects of bone marrow-derived mononuclear cell transplantation combined with off-pump coronary artery bypass surgery in patients with ischemic heart disease. J Nucl Med. 2005; 46 (10) 1610-1617
- 18 Al-Sheikh T, Allen K B, Straka S P, Heimansohn D A, Fain R L, Hutchins G D et al. Cardiac sympathetic denervation after transmyocardial laser revascularization. Circulation. 1999; 100 (2) 135-140
- 19 Gassler N, Wintzer H O, Stubbe H M, Wullbrand A, Helmchen U. Transmyocardial laser revascularization. Histological features in human nonresponder myocardium. Circulation. 1997; 95 (2) 371-375
- 20 Lutter G, Schwarzkopf J, Lutz C, Martin J, Beyersdorf F. Histologic findings of transmyocardial laser channels after two hours. Ann Thorac Surg. 1998; 65 (5) 1437-1439
- 21 Lutter G, Saurbier B, Nitzsche E, Kletzin F, Martin J, Schlensak C et al. Transmyocardial laser revascularization (TMLR) in patients with unstable angina and low ejection fraction. Eur J Cardiothorac Surg. 1998; 13 (1) 21-26
- 22 Kraatz E G, Misfeld M, Jungbluth B, Sievers H H. Survival after transmyocardial laser revascularization in relation to nonlasered perfused myocardial zones. Ann Thorac Surg. 2001; 71 (2) 532-536
- 23 Menasche P, Hagege A A, Vilquin J T, Desnos M, Abergel E, Pouzet B et al. Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction. J Am Coll Cardiol. 2003; 41 (7) 1078-1083
MD Efstratios I. Charitos
Cardiac and Thoracic Vascular Surgery Clinic
University of Lübeck
Ratzeburger Allee 160
23538 Lübeck
Germany
Phone: + 49 45 15 00 47 63
Fax: + 49 45 15 00 20 51
Email: efstratios.charitos@gmail.com