Direct intramyocardial percutaneous delivery of autologous bone marrow in patients with refractory myocardial angina

• Published in: The American heart journal 2006-03, Vol.151 (3), p.674-680
• Main Authors: Briguori, Carlo, Reimers, Bernhard, Sarais, Cristiano, Napodano, Massimo, Pascotto, Pietro, Azzarello, Giuseppe, Bregni, Marco, Porcellini, Adolfo, Vinante, Orazio, Zanco, Pierluigi, Peschle, Cesare, Condorelli, Gianluigi, Colombo, Antonio
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Angina Pectoris - physiopathology; Angina Pectoris - surgery; Biological and medical sciences; Bone marrow; Bone Marrow Cells; Bone Marrow Transplantation; Cardiology. Vascular system; Colony-Forming Units Assay; Coronary Angiography; Coronary heart disease; Coronary vessels; Delivery. Postpartum. Lactation; Feasibility Studies; Female; Gynecology. Andrology. Obstetrics; Heart; Heart attacks; Humans; Immunophenotyping; Injections, Intralesional; Male; Medical sciences; Middle Aged; Neovascularization, Physiologic; Pilot Projects; Quality of Life; Studies; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Treatment Outcome
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2005.04.033

Intramyocardial injection of autologous bone marrow (ABM) may induce angiogenesis. We tested the safety and feasibility of catheter-based direct percutaneous intramyocardial delivery of ABM in patients with refractory angina pectoris. Ten patients (9 men, 67 ± 8 years) with refractory angina (Canadian Cardiovascular Society class III-IV) and documented myocardial ischemia were enrolled. After left ventricular electromechanical mapping, freshly aspirated and filtered ABM was percutaneously injected into target myocardial ischemic areas. Clinical symptoms (as assessed according to the Canadian Cardiovascular Society class), quality of life, and myocardial perfusion were evaluated before the procedure and through the follow-up. In all patients, ABM was successfully injected into the target regions. No periprocedural complications occurred. At 12 months, no major cardiac events (death, acute myocardial infarction, stroke, and malignant ventricular arrhythmias) occurred. Severity of angina improved of ≥2 classes in 3 patients. Quality of life showed a significant improvement in all patients. Myocardial perfusion in the target regions improved in 4 of 8 patients. Direct percutaneous intramyocardial delivery of ABM appears feasible and safe. Further evaluation is warranted to test its clinical efficacy.