Akademik Veri Yönetim Sistemi
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, cilt.36, sa.4, ss.633-643, 2009 (SCI-Expanded)
Objective: Cell therapy for patients with ischaemic cardiomyopathy (IC) is still an open issue. We aimed to assess the long-term safety and therapeutic potency of autologous bone marrow mononuclear cell (ABMMNC) implantation into ungraftable coronary artery (UCA) territories in patients with IC. Methods: Bone marrow was aspirated from the iliac crest, and transepicardial ABMMNC implantation (n = 25, 24 men, aged 57 +/- 7 years) as an adjunct to coronary artery bypass grafting (CABG) was performed into an area of reversible ischaemia within the territory of UCA (1.29 +/- 0.09 x 10(9) ABMMNCs). Control group In = 25, 23 men, aged 59 7 years) underwent incomplete CABG due to poor target vessel graftability. The study protocol consisted of coronary angiography, stress echocardiography, nuclear imaging and Hotter monitoring at baseline and follow-up. The mean follow-up time was 988 +/- 423 days. Results: There was no difference between the groups regarding postoperative complications and outcome. Overall 5-year survival for the ABMMNC group was 79 +/- 10%, and 71 +/- 112% for the controls (p = 0.48). Left ventricular ejection fraction (LVEF) at baseline was 24.8 +/- 3.7 versus 25.9 +/- 3.1 in the ABMMNC group and the controls, respectively. After 6 months, mean global LVEF increased to 36.3 +/- 7.4 (p < 0.001) versus 31.4 +/- 4.1 (p = 0.001), respectively. A significant difference was noted in delta LVEF between the groups (p < 0.001, 95% confidence interval (Cl): 3.4-8.9) at 6 months, and (p = 0.001, 95% CI: 2.0-7.4) at 1 year. Accordingly, perfusion scores in UCA segments detected by single-photon emission computed tomography (SPECT) improved with ABMMNC therapy to 18.0 +/- 24.4 from 7.1 +/- 25.7 (p = 0.001 vs control UCA segments). Conclusion: Cellular therapy for IC within UCA could augment myocardial perfusion and contractility but does not improve overall survival. No adverse events were detected after cell therapy at mid-term follow-up. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.