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
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 conclusion...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2015-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400071T.pdf |
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| author | Trifunović Zoran Obradović Slobodan Balint Bela Ilić Radoje Vukić Zoran Šišić Marija Kostić Jelena Rusović Siniša Dobrić Milan Ostojić Gordana |
| author_facet | Trifunović Zoran Obradović Slobodan Balint Bela Ilić Radoje Vukić Zoran Šišić Marija Kostić Jelena Rusović Siniša Dobrić Milan Ostojić Gordana |
| author_sort | Trifunović Zoran |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-14f11754eef3493f841b82992f17cbff |
| institution | DOAJ |
| issn | 0042-8450 |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-14f11754eef3493f841b82992f17cbff2025-08-20T03:17:22ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502015-01-0172322523210.2298/VSP140109071T0042-84501400071TFunctional 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 studyTrifunović Zoran0Obradović Slobodan1Balint Bela2Ilić Radoje3Vukić Zoran4Šišić Marija5Kostić Jelena6Rusović Siniša7Dobrić Milan8Ostojić Gordana9Military Medical Academy, Cardiac Surgery Clinic, Belgrade + University of Defense, Faculty of Medicine of the Military Medical Academy, BelgradeUniversity of Defense, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Clinic for Emergency and Internal Medicine, BelgradeUniversity of Defense, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Transfusiology and Hemobiology, BelgradeMilitary Medical Academy, Cardiac Surgery Clinic, Belgrade + University of Defense, Faculty of Medicine of the Military Medical Academy, BelgradeMilitary Medical Academy, Clinic for Anestesiology and Intensive Care, BelgradeMilitary Medical Academy, Nuclear Medicine Institute, BelgradeDepartment of Cardiology, Clinical Center of Serbia, BelgradeMilitary Medical Academy, Radiology Institute, BelgradeClinical Center of Serbia, Department of Cardiology, BelgradeUniversity of Defense, Faculty of Medicine of the Military Medical Academy, Belgrade + Military Medical Academy, Institute for Transfusiology and Hemobiology, BelgradeBackground/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.http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400071T.pdfcoronary artery bypassbone marrow transplantationmyocardiumintraoperative periodphysical endurancemortality |
| spellingShingle | Trifunović Zoran Obradović Slobodan Balint Bela Ilić Radoje Vukić Zoran Šišić Marija Kostić Jelena Rusović Siniša Dobrić Milan Ostojić Gordana 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 Vojnosanitetski Pregled coronary artery bypass bone marrow transplantation myocardium intraoperative period physical endurance mortality |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | coronary artery bypass bone marrow transplantation myocardium intraoperative period physical endurance mortality |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2015/0042-84501400071T.pdf |
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