Abstract 3694: Long-Term Clinical and Functional Results of Intramyocardial CD 133+ Bone Marrow Stem Cell Transplantation for Ischemic Myocardial Failure
Aims: Numerous studies employing cell-based therapies provided improvement of myocardial performance in ischemic heart disease. We aimed to explore long-term outcome after intramyocardial CD 133+ bone marrow stem cell transplantation (ScTx) during CABG and mitral valve repair.
Methods and Results: Patients (n=35) after ScTx and CABG (Sc-CABG) were compared to a control group (Co-CABG) of 20 patients, who received CABG surgery only. Additionally, outcome in patients (n=10) with ischemic mitral valve regurgitation was analyzed after mitral valve repair and ScTx (Sc-MVR). Clinical effects were assessed using the NYHA score and the Minnesota questionnaire (MLFHQ). Electrocardiography, 24-hour Holter monitoring, echocardiography, myocardial perfusion scanning, cardiac magnetic resonance imaging and computed tomography were performed. The long term survival was excellent about up to five years in the Sc-CABG group. Three patients (70%) died in the Sc-MVR group between 6 –12 months after therapy. Progressive heart failure was observed in two of these cases. During follow-up no sustained ventricular rhythm disturbances or adverse tissue changes were detected in the ScTx-patients. The Sc-CABG group revealed explicitly better NYHA and MLFHQ scores than the Co-CABG group. Echocardiography showed preserved left ventricular function in both CABG groups, whereas the left ventricular enddiastolic volume decreased in long term only in the ScTx patients (Sc-CABG vs, Co-CABG p=0.043; LVEDD in Sc-MVR after two years 60.8 mm vs. 67.3 mm preoperatively). The myocardial perfusion scores at the area of risk were significantly increased in the ScTx patients (Sc-CABG group after 36 months p=0.024 vs. control, Sc-MVR p<0.01 vs. preoperative value). The observed reverse remodeling in the surviving Sc-MVR patients was confirmed by an increase in LVEF at two years after ScTx (LVEF preoperative: 26.5% vs. 2 years: 33.7).
Conclusion: Excellent long-term safety and survival can be achieved with intramyocardial ScTx and CABG surgery. For the first time, we report promising results of reverse remodeling after ScTx in patients with ischemic mitral valve disease.