Autologous transplantation of bone marrow mononuclear stem cells by mini-thoracotomy in dilated cardiomyopathy: technique and early results

Sao Paulo Medical Journal

Renato Abdala Karam Kalil¹  Daniele Ott¹  Roberto Sant'anna¹  Eduardo Dias¹  João Pedro Marques-pereira¹  Andrés Delgado-cañedo¹  Nance Beyer Nardi¹  João Ricardo Michelin Sant'anna¹  Paulo Roberto Prates¹  Ivo Nesralla¹ 

[1],Fundação Universitária de Cardiologia Instituto de Cardiologia do Rio Grande do Sul Porto Alegre Rio Grande do Sul ,Brazil

关键词: Dilated cardiomyopathy;    Stem cells;    Heart surgery;    Heart failure;    congestive;    Cell transplantation;    Cardiomiopatia dilatada;    Células-tronco;    Cirurgia torácica;    Insuficiência cardíaca congestiva;    Transplante celular;   

DOI  :  10.1590/S1516-31802008000200003

来源: SciELO

【 摘 要 】

CONTEXT AND OBJECTIVES: There are few studies concerning bone marrow mononuclear cell (BMMC) transplantation in cases of nonischemic dilated cardiomyopathy. This study describes a novel technique of BMMC transplantation and the results up to one year after the procedure. DESIGN AND SETTING: This was a case series to evaluate the safety and viability of the procedure, at Instituto de Cardiologia do Rio Grande do Sul. METHODS: Nine patients with symptomatic dilated cardiomyopathy, functional class III/IV and left ventricular ejection fraction (LVEF) < 35% received BMMC (9.6 ± 2.6 x 107 cells) at 20 sites in the ventricular wall, by means of thoracotomy of length 5 cm in the fifth left intercostal space. Echocardiograms and nuclear magnetic resonance (NMR) were performed. RESULTS: There were no major complications. The functional class results for the first six patients (preoperatively and at two, four, eight and twelve-month follow-ups, respectively) were: [IV-2, III-4] to [I-5, II-1] to [I-3, II-3] to [I-2, II-3] and [I-2, II-3]. Echocardiograms showed LVEF: 25.9 ± 8.2; 32.9 ± 10.4; 29.4 ± 7.2; 25.1 ± 7.9; 25.4 ± 6.8% (p = 0.023); and % left ventricular (LV) fiber shortening: 12.6 ± 4.4; 16.4 ± 5.4; 14.3 ± 3.7; 12.1 ± 4.0; 12.2 ± 3.4% (p = 0.021). LV performance variation seen on NMR was non-significant. CONCLUSION: Intramyocardial transplantation of BMMC in dilated cardiomyopathy cases is feasible and safe. There were early improvements in symptoms and LV performance. Medium-term evaluation revealed regression of LV function, although maintaining improved functional class.

【 授权许可】

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