Thorac Cardiovasc Surg 2009; 56 - P124
DOI: 10.1055/s-0029-1191714

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

EI Charitos 1, J Babin-Ebell 1, EG Kraatz 1, HA Sier 1, KF Wagner 2, HH Sievers 1
  • 1UKSH-Campus Luebeck, Klinik für Herzchirurgie, Luebeck, Germany
  • 2Südstadt Klinik, Clinic of Anesthesiology, Rostock, Germany

Objective: Several patients with ischemic heart disease suffer from disabling angina and/or congestive heart failure despite conventional medical therapy and revascularization procedures. Combining transmyocardial laser revascularisation for angina relief and potential cellular signalling with intramyocardial autologous endothelial progenitor cell injection for neoangiogenesis may offer a new treatment strategy for this patient population.

Methods: Combined transmyocardial laser revascularisation and intramyocardial injection of bone marrow derived CD133+cells was performed in six highly symptomatic patients. Between 11 and 27 laser channels were created and the isolated CD133+ cells were injected intramyocardially (6–12 injections). All patients were followed 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 from a mean of 3.4 grades preoperatively, to 1.8 grades up to 12 months postoperatively. Left ventricular ejection fraction improved (48.8±18% preoperatively, 59.6±16% 3 months, 61.6±20% 6 months). Left ventricular end-diastolic volume and myocardial perfusion varied between the patients. On a custom quality of life scale (1–10), all patients described a considerable quality of life improvement postoperatively (7.4 preoperatively, 3.6at 3-months and 3.2at 6-months. Repeated 24 hour Holter monitoring revealed no significant arrhythmias.

Conclusions: In this small patient cohort, intramyocardial CD 133+cell injection combined with transmyocardial laser revascularisation lead to an improvement in clinical symptomatology and left ventricular function, with an unclear effect on myocardial perfusion.