Safety and feasibility of percutaneous retrograde coronary sinus delivery of autologous bone marrow mononuclear cell transplantation in patients with chronic refractory angina

Jorge Tuma, Roberto Fernández-Viña, Antonio Carrasco, Jorge Castillo, Carlos Cruz, Alvaro Carrillo, Jose Ercilla, Carlos Yarleque, Jaime Cunza, Timothy D Henry, Amit N Patel, Jorge Tuma, Roberto Fernández-Viña, Antonio Carrasco, Jorge Castillo, Carlos Cruz, Alvaro Carrillo, Jose Ercilla, Carlos Yarleque, Jaime Cunza, Timothy D Henry, Amit N Patel

Abstract

Background: Chronic refractory angina is a challenging clinical problem with limited treatment options. The results of early cardiovascular stem cell trials using ABMMC have been promising but have utilized intracoronary or intramyocardial delivery. The goal of the study was to evaluate the safety and early efficacy of autologous bone marrow derived mononuclear cells (ABMMC) delivered via percutaneous retrograde coronary sinus perfusion (PRCSP) to treat chronic refractory angina (CRA).

Methods: From May 2005 to October 2006, 14 patients, age 68 +/- 20 years old, with CRA and ischemic stress-induced myocardial segments assessed by SPECT received a median 8.19*10(8) ± 4.3*10(8) mononuclear and 1.65*10(7) ± 1.42*10(7) CD34(+) cells by PRCSP.

Results: ABMMC delivery was successful in all patients with no arrhythmias, elevated cardiac enzymes or complications related to the delivery. All but one patient improved by at least one Canadian Cardiovascular Society class at 2 year follow-up compared to baseline (p < 0.001). The median baseline area of ischemic myocardium by SPECT of 38.2% was reduced to 26.5% at one year and 23.5% at two years (p = 0.001). The median rest left ventricular ejection fraction by SPECT at baseline was 31.2% and improved to 35.5% at 2 year follow up (p = 0.019).

Conclusions: PRCSP should be considered as an alternative method of delivery for cell therapy with the ability to safely deliver large number of cells regardless of coronary anatomy, valvular disease or myocardial dysfunction. The clinical improvement in angina, myocardial perfusion and function in this phase 1 study is encouraging and needs to be confirmed in randomized placebo controlled trials.

Figures

Figure 1
Figure 1
A: Unselected transplantation of BMC into the coronary veins, B: Selected transplantation of BMC into the lateral veins.
Figure 2
Figure 2
Clinical outcomes of angina class.
Figure 3
Figure 3
Exercise Capacity.
Figure 4
Figure 4
A: Perfusion imaging in a patient at 2 year follow up, B: Perfusion imaging in another patient at 2 year follow up.
Figure 5
Figure 5
Functional evaluation of myocardium.

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