scholarly journals Functional recovery of patients with ischemic cardiomyopathy treated with coronary artery bypass surgery and concomitant intramyocardial bone marrow mononuclear cell implantation: A long term follow-up study

2015 ◽  
Vol 72 (3) ◽  
pp. 225-232 ◽  
Author(s):  
Zoran Trifunovic ◽  
Slobodan Obradovic ◽  
Bela Balint ◽  
Radoje Ilic ◽  
Zoran Vukic ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Ischemic Cardiomyopathy ◽  
Mononuclear Cells ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bone Marrow Mononuclear Cells ◽  
Cabg Surgery ◽  
To Receive

Background/Aim. Intramyocardial bone marrow mononuclear cells (BMMNC) implantation concomitant to coronary artery bypass grafting (CABG) surgery as an option for regenerative therapy in chronic ischemic heart failure was tested in a very few number of studies, with not consistent conclusions regarding improvement in left ventricular function, and with a follow-up period between 6 months and 1 year. This study was focused on testing of the hypothesis that intramyocardial BMMNC implantation, concomitant to CABG surgery in ischemic cardiomyopathy patients, leads to better postoperative long-term results regarding the primary endpoint of conditional status-functional capacity and the secondary endpoint of mortality than CABG surgery alone in a median follow-up period of 5 years. Methods. A total of 30 patients with ischemic cardiomyopathy and the median left ventricular ejection fraction (LVEF) of 35.9 ? 4.7% were prospectively and randomly enrolled in a single center interventional, open labeled clinical trial as two groups: group I of 15 patients designated as the study group to receive CABG surgery and intramyocardial implantation of BMMNC and group II of 15 patients as the control group to receive only the CABG procedure. All the patients in both groups received the average of 3.4 ? 0.7 implanted coronary grafts, and all of them received the left internal mammary artery (LIMA) to the left anterior descending (LAD) and autovenous to other coronaries. Results. The group with BMMNC and CABG had the average of 17.5 ? 3.8 injections of BMMNC suspension with the average number of injected bone marrow mononuclear cells of 70.7 ? 32.4 ? 106 in the total average volume of 5.7 ? 1.5 mL. In this volume the average count of CD34+ and CD133+ cells was 3.96 ? 2.77 ? 106 and 2.65 ? 1.71 ? 106, respectively. All the patients were followed up in 2.5 to 7.5 years (median, 5 years). At the end of the follow-up period, significantly more patients from the group that received BMMNC were in the functional class I compared to the CABG only group (14/15 vs 5/15; p = 0.002). After 6 months the results on 6-minute walk test (6-MWT) were significantly different between the groups (435 m in the BMMNC and CABG group and 315 m in the CABG only group; p = 0.001), and continued to be preserved and improved on the final follow-up (520 m in the BMMNC and CABG group vs 343 m in the CABG only group; p < 0.001). Cardiovascular mortality was also significantly reduced in the BMMNC and CABG group (p = 0.049). Conclusion. Implanatation of BMMNC concomitant to CABG is a safe and feasible procedure that demonstates not only the improved functional capacity but also a reduced cardiac mortality in a 5-year follow-up in patients with ischemic cardiomyopathy scheduled for CABG surgery.

Abstract 14915: Incidence, Predictors and Clinical Impact of Left Ventricular Functional Recovery Following Coronary Artery Bypass Grafting in Patients With Ischemic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Masaro Nakae ◽  
Satoshi Kainuma ◽  
Koichi Toda ◽  
Shigeru Miyagawa ◽  
Daisuke Yoshioka ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Lv Function ◽  
Term Survival ◽  
Function Recovery ◽  
Lv Remodeling ◽  
Relationship Of

Introduction: CABG is considered the standard treatment for patients with ischemic cardiomyopathy (ICM). However, it remains unknown who would achieve postoperative LV function recovery after CABG. Furthermore, the relationship of postoperative LV function recovery with long-term outcomes remains unclear. Hypothesis: In patients with ICM who undergo CABG, postoperative LV function recovery, which would be influenced by degree of LV remodeling at baseline, is associated with improved outcomes. Methods: This multicenter retrospective study comprised 490 cases with LVEF of ≤40% who underwent CABG between 1993 and 2015. Clinical follow-up was completed in 467 cases (95%), with a mean follow-up of 65±46 months (range, 0-266). A total of postoperative echocardiographic assessments were carried with an average number of 3.7±2.4. LV function recovery was defined as LVEF ≥35% at more than one exam. Association of LV function recovery with mortality after adjustments for clinically relevant covariates was estimated using Cox proportional hazard model. Pre- and intraoperative associates of LV function recovery were identified using logistic regression model. Results: During follow-up, there were 203 mortalities (41%) and overall 10-year survival was 45%. LV function recovery was found in 368 cases (75%), while not in 122 (25%). Overall 10-year survival was significantly higher in patients who achieved LV function recovery as compared with those who did not achieve it (52% vs. 23%). Multivariate analysis identified LV function recovery was independently associated with decreased overall mortality (adjusted HR 0.40, p<0.0001). Preoperative LVDs (adjusted OR 0.92, p<0.0001), eGFR (adjusted OR 1.12, p=0.016) and revascularization using bilateral internal thoracic arteries (BITA) (adjusted OR 2.81, p=0.018) are the independent predictors of LV function recovery. Conclusions: Among patients with ICM who underwent CABG, 75% achieved substantial postoperative LV function recovery, in association with better long-term survival, as compared with the remaining 25% of patients who did not achieve it. Preoperative less LV remodeling and preserved renal function as well as revascularization with use of BITA might be associated with LV function recovery.

Abstract 2298: Impact of Preopeartive Anemia on Long-term Outcomes Following Isolated Coronary Artery Bypass Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yan Li ◽  
Zhe Zheng ◽  
Shiju Zhang ◽  
Xianqiang Wang ◽  
Huawei Gao ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Total Mortality ◽  
Long Term Outcomes ◽  
Preoperative Anemia ◽  
Cabg Surgery ◽  
Repeated Revascularization

Background: The prognostic and clinical value of preopeartive anemia in patients undergoing cardiac surgery has recently been recognized. However, very limited information exists on the impact of preopeartive anemia on long-term outcomes following coronary artery bypass graft (CABG) surgery. This study aimed at examining the degree to which preopeartive anemia affects long-term outcomes after isolated CABG surgery. Methods: A unicenter study was conducted on 5488 consecutive survivors of isolated CABG between January 1999 and December 2005. Preopeartive anemia was defined according to the World Health Organization definition (hemoglobin < 13g/dL for male; hemoglobin < 12g/dL for female). Long-term outcomes of interest were total mortality, myocardial infarction (MI), repeated revascularization, and major adverse cardiac events (MACEs=total mortality or MI or repeated revascularization). These outcomes were compared after adjustment for differences in baseline risk factors among the patients. Results: 1437 (26.2%) patients had preoperative anemia. After a mean follow-up of 43.3±18.3 months, preoperative anemia was found to be an independent risk factor for total mortality (hazard ration [HR]: 1.490; 95% CI: 1.074 to 2.067; p=0.017), MI (HR: 1.595; 95% CI: 1.028 to 2.474; p=0.037) and MACEs (HR: 1.363; 95% CI: 1.059 to 1.755; p=0.016). We also found that aspirins and beta-blockers were underused in patients with anemia during follow-up. Conclusions: Preopeartive anemia has a strong negative impact on long-term outcomes following isolated CABG. Our data also suggest that the incorporation of preoperative anemia into the risk assessments of long-term outcomes after CABG is recommended. Future intense and systematic studies are needed to help ensure high-quality cardiac care of patients with anemia.

Abstract 20556: Safety and Efficacy of Intracoronary Hypoxia-PrecondItioned Bone Marrow Mononuclear Cells Administration for Acute Myocardial Infarction Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Xin Yang Hu ◽  
Xin Huang ◽  
Qian Yang ◽  
Lihan Wang ◽  
Jianzhong Sun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Bone Marrow ◽  
Primary Endpoint ◽  
Perfusion Defect ◽  
Mononuclear Cells ◽  
Left Ventricular ◽  
Bone Marrow Mononuclear Cells ◽  
Safety And Efficacy ◽  
Intracoronary Infusion

IMPORTANCE: Cell therapy has been a potential approach for ST-segment elevation acute myocardial infarction (STEMI). To improve the therapeutic oucome, the safety and efficacy of hypoxia-preconditioned (H-) bone marrow mononuclear cells (BMCs) in AMI patients need further evaluation. OBJECTIVE: To investigate the safety and efficacy of H-BMCs therapy in AMI patients. DESIGN: A phase 1, randomized and blinded study (February, 2011~ March, 2012) with one-year of follow-up. SETTING: A single center for hospitalized care. PARTICIPANTS: 22 Patients with an acute ST elevation myocardial infarction were recruited and randomized to two groups: normoxia BMCs (N-, n=11) and H-BMCs (n=11). INTERVENTIONS: Intracoronary infusion of H-BMCs or N-BMCs within 5-7 days after treatment with percutaneous transluminal coronary intervention (PCI). Patients were similarly treated by a stop-flow technique through an over-the-wire balloon catheter. MAIN OUTCOMES AND MEASURES: Primary endpoint was Treatment-emergent 30-day serious adverse event rate defined as a composite of death, MI, sustained ventricular tachycardia, stroke, hospitalization for worsening heart failure and revascularization. Secondary endpoints were change of myocardium perfusion, global left ventricular ejection fraction and left ventricular volumes. RESULTS: The primary endpoint events was none for N-BMCs and 9.1% (95% CI, 0.2%-41.3%) for H-BMCs. There was significant increase in the change of LVEF of H-BMCs group at 6 month. The change of end diastolic volume (EDV) and end systolic volume (ESV) in H-BMCs at 12 month were significantly decreased. Ratio of myocardium perfusion defect by Single-Photon Emission Computed Tomography (SPECT) was significantly reduced in H-BMCs group at 6 months, and score of myocardium perfusion defect by SPECT was significantly reduced than that of baseline in H-BMCs group at 6 and 12 months, unlike N- group. CONCLUSIONS AND RELEVANCE: Intracoronary infusion with H-BMCs appeared to be safe and effective for patients with AMI. Although the sample size precludes a definitive statement about safety and efficacy, these results provide the basis for larger studies to provide definitive evidence about safety and to assess efficacy of this new therapeutic approach.

scholarly journals FIVE YEARS CLINICAL FOLLOW-UP OF PATIENTS TREATED WITH COMBINED DELIVERY OF INTRACORONARY AND INTRAMYOCARDIAL BONE-MARROW MONONUCLEAR CELLS

2011 ◽  
Vol 57 (14) ◽  
pp. E1965
Author(s):  
Mariann Gyongyosi ◽  
Irene Lang ◽  
Markus Dettke ◽  
Dietmar Glogar ◽  
Gilbert Beran ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Mononuclear Cells ◽  
Bone Marrow Mononuclear Cells
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