Autologous in vitro expanded mesenchymal stem cell therapy for human old myocardial infarction

Stem cell transplantation after myocardial infarction has been claimed to restore cardiac function. Mesenchymal stem cells attract a lot of attention because of the feasibility of in vivo and ex vivo differentiation to cardiomyocytes and endothelial cells as well as their trophic effect on tissue repair. In this study, we investigated the efficacy of autologous bone marrow derived mesenchymal stem cells in improving heart function in patients with old myocardial infarction. Eight patients with old myocardial infarction and proper inclusion criteria were injected with mesenchymal stem cells at the time of coronary artery bypass grafting or percutaneous coronary intervention [test group] and compared with eight matched patients who received the same treatment without mesenchymal stem cell injection [control group]. Evaluation of heart function was done by echocardiography plus single-photon emission computed tomography before and six months after the procedure. Serial clinical examination was performed every month through New York Heart Association class. The mean New York Heart Association class and single-photon emission computed tomography scan results decreased significantly in the test group [P=0.000 and 0.002, respectively] and in the control group [P=0.049 and 0.007, respectively] after the procedure at six months follow-up. Left ventricular ejection fraction increased significantly in the test group [P< 0.005] but not in the control group. In comparison between the test and control groups the results of New York Heart Association class assessment and single-photon emission computed tomography demonstrated significant improvement in the test group [P=0.005 and 0.013, respectively]. There were no significant differences between the baseline variables in the two groups. In conclusion transplantation of ex vivo expanded bone marrow derived mesenchymal stem cell in patients with old myocardial infarction is a safe and feasible procedure. These cells improve the cardiac fimction without serious adverse effects

Repeat percutaneous mitral valvuloplasty [PMV] in patients with restenosis following to previous PMV

Symptomatic mitral restenosis developed in 4% to 39% of patients after PMV. It is unknown that these patients may benefit from repeat percutaneous mitral valvuloplasty [PMV]. This study assesses the immediate and early outcomes of redo PMV in patients with restenosis after prior PMV. Our study report the immediate and early outcome of 54 patients [mean age 38 +/- K2 years, 14 women and 40 male] with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PMV at 3.8+2.4 years after the initial PMV. After the procedure there was a substantial increase in mitral valve area [MVA] from 1.0 + 0.2 to2.2 +/- 0.4 cm [p<0.001] and a decrease in left atrial pressure from 27+8 to 15 +/- 6mm Hg [p<0.001] and in mitral valve gradient from 17+4 to 2+1 mm Hg [P <0.001]. Mean pulmonary artery pressure did not change significantly with redo-PMV. No patient developed severe mitral regurgitation [3+] after redo PMV. Successful procedural outcome [post-PMV mitral valve area>=l .5 cm[2], pulmonary /systemic flow ratio=

Stem cell transplantation and cardiac repair. A systematic review of its current and future status

After myocardial infarction, injured cardiomyocytes are replaced by fibrotic tissue promoting the development of heart failure. Stem cells are multipotent, undifferentiated cells capable of multiplication and differentiation. Preliminary experimental evidence suggests that stem cells derived from embryonic or adult tissues [especially bone marrow] may develop into myocardial cells. The overall clinical experience also suggests that stem cell therapy can be safely performed, if the right cell type is used in the right clinical setting. Preliminary efficacy data indicate that stem cells have the potential to enhance myocardial perfusion and/or contractile performance in patients with acute myocardial infarction, advanced coronary artery disease, and chronic heart failure. However, at the present time, the results have been mixed and inconclusive, and the mechanism of stem cell transplantation therapy remains unclear. This review discusses the controversies and problems that need to be addressed in future investigations

Postoperative mortality and morbidity in elderly patients undergoing coronary artery bypass graft surgery

Elderly patients [>75 years] have constituted the fastest growing portion of the coronary artery bypass grafting [CABG] patient population over the last two decades. Of the goals that surgical care for the elderly pursues, cure may be an unfeasible one; nevertheless, palliation and comfort warrant sufficient importance. The present study sought to examine the postoperative course and events in elderly patients undergoing CABG with or without other procedures and to compare the results with those in younger patients. Demographic, mortality, morbidity, and resource utilization data were collected from the records of the patients undergoing CABG between January 2005 and July 2007 in Imam Khomeini Medical Center, Tehran, Iran. The mean time to extubation was 9.3 and 6.3 hours in the elderly and non-elderly patients, respectively [p < 0.01]. Blood transfusion was required in 87.8% of the elderly compared to 58.5% of the non-elderly subjects [p < 0.01]. The mean Intensive Care Unit stay was 2.1 days for the elderly and 1.4 days for the non-elderly patients [p < 0.001]. In-hospital mortality was 9% for the elderly patients vs. 2.8% for the younger group [p < 0.001]. The elderly patients undergoing CABG had a significantly higher morbidity rate, with an increased incidence of postoperative renal failure, neurological complications, and in-hospital mortality