Feasibility of transplanting bone marrow mononuclear cells into bypass graft to improve therapeutic efficiency for coronary artery patients / 中国组织工程研究

ABSTRACT

BACKGROUND: Currently, most of the clinical trials of cell transplantation for ischemic heart disease is the transplantation of bone marrow mononuclear cells through the bypass graft artery in patients with acute myocardial infarction, but reports in combination with cell transplantation for old myocardial infarction are few. OBJECTIVE: To investigate the safety and feasibility of intracoronary artery injection of bone marrow mononuclear cells through the bypass graft artery during coronary artery bypass grafting (CABG). DESIGN: Self-control and case analysis. PARTICIPANTS: A total of 10 patients who had old myocardial infarction, left ventricular ejection fraction (LVEF)≤40%, were selected from Cardiovascular Institute and Fuwai Hospital from November 2004 to June 2005. METHODS: The bone marrow mononuclear cells were harvested from the bone marrow by Ficoll density gradient centrifugation method before the CABG was carried. And the patients received CABG and 10 mL mononuclear cell suspension through the grafts into anterior descending branch. In addition, 10 mL mononuclear cell suspension was injected into the circumflex branch and right coronary artery through the proximal heart. MAIN OUTCOME MEASURES: The heart function was evaluated with transthoracic echocardiography (TEE) and cardiac MRI after the operation. RESULTS: All patients recovered. A total of 45-60 mL bone marrow was harvested from iliac crest, and 4.1 ×10~7 mononuclear cells were isolated and identified by trypan blue test (cell activity >95%). TEE showed that the LVEF at 1 week and 1, 3 months postoperatively was significantly improved compared with before operation; creatase arid troponin T were not increased, and no myocardial infarction changes were found. MRI showed that the LVEF was significantly increased following operation (P < 0.01); left ventricular end-diastolic and systolic diameters were significantly decreased (P < 0.05). There was no complication associating with bone marrow harvest, or cell transplantation. CONCLUSION: Bone marrow mononuclear cells transplantation through bypass graft, as an adjunctive therapy, is safe and feasible.