Abstract 12808: Transendocardial Cell Injection is Not Superior to Intracoronary Infusion in a Porcine Model of Chronic Ischemic Heart Disease: A Randomized Study on Efficiency Using Nuclear Imaging
Introduction: Stem cell therapy is a new strategy for chronic ischemic heart disease in patients, however, no consensus exists on the most optimal delivery strategy.
Hypothesis: This randomized study was designed to assess cell delivery efficiency of intracoronary (IC), transendocardial (TE) and surgical delivery in a chronic pig model of ischemia-reperfusion injury.
Methods: Twenty-one animals underwent delivery of 107 autologous Indium-oxine labeled bone marrow-derived mesenchymal stem cells (MSC) 4 weeks after infarction and were randomized to 1 of 3 groups (n=7 each group): IC, TE using electromechanical mapping guidance (NOGA) or surgical delivery. Primary endpoint was defined as percentage (%) of injected dose per organ and assessed by in vivo gamma-emission counting.
Results: No significant difference in hemodynamics was observed. Troponin and intracoronary flow (Thrombolysis in Myocardial Infarction score) did not differ between the percutaneous groups. Blinded endpoint analysis showed no significant difference in efficiency after surgical injection (16±4%) compared with IC (11±1%) and TE (11±3%) (Fig 1; P=0.52). IC showed less variability in efficiency compared with TE and surgical injection. Our segmental analysis by gamma-scan showed a higher local retention of MSC from apex till mid-papillary level after TE and surgical injection in the ischemic area compared with uniform distribution of cells after IC. Overall, TE injection showed less distribution of MSC to visceral organs compared with other modalities.
Conclusions: This randomized study showed no significant difference in cell delivery efficiency to the myocardium in a clinically relevant ischemic large animal model. These results suggest that, in addition to functional outcome, the choice of percutaneous cell delivery modality could depend on medical indication and practical aspects, since TE and IC yield similar results.
- © 2011 by American Heart Association, Inc.