REFRACTORY ANGINA (RA)
TREATMENT BY PERCUTANEOUS RETROGRADE SINUS TECHNIQUE (PRST)
TRASPLANTATION OF UNSELECTED AUTOLOGOUS BONE MARROW
MONONUCLEAR CELLS (ABMMC). REPORT OF TECELCOR-PERU
Author
Block J. Tuma-Mubarak1, R.
Fernández-Viña2, J. F.
Castillo-Aguirre3, A. A.
Carrasco-Yalán3, H. N. Ríos-Díaz3, R. De
Moura4, C. Cruz5, M. Vargas6,
A. Carrillo7, N. Gómez7, S.
Chirinos7, M. Aranda7, J.
Rafael7;
1Clínica San Felipe,
Clinica Ricardo Palma, Clínica Maisón de Santé y Fundación
Peruana de Terapia Regenerativa, Lima, PERU,
2Centro Cardiovascular San Nicolás, Don Roberto
Fernandez Viña Fundation, San Nicolás, ARGENTINA,
3Instituto de Crío Preservación y Terapia Celular,
Lima, PERU, 4Univ. Fluminense, Rio de Janeiro,
BRAZIL, 5Medicina Nuclear Clínica San Felipe, Lima,
PERU, 6Ecocardiografía Clínica San Felipe, Lima,
PERU, 7Diagnostico y tratamiento intervencionista
Clínica Ricardo Palma, Lima, PERU.
Transcoronary
unselected and selected ABMMC implant had shown clinical and
imaging benefit in patients with acute and chronic myocardial
disease. PRST had demonstrated to be useful in poorly perfused
ventricular areas.
During May to October 2005, 10 patients,
median age 65 years old (range 41-81), male/female ratio 9/1;
with infarcted and ischemic myocardium, functional class (CCF)
III-IV RA, 80% had grade II-III congestive cardiac failure
(NYHA) and two patient grade IV. None of these patient were
candidates for myocardial revascularization surgery neither
angioplasty. Basal ejection fraction (EF) was 40.5% (range
30-69).
After signed informed consent, a median volume of
264 ml (range 210-350) of bone marrow was obtained from iliac
puncture.
Concentrated cells were implanted retrogradely by
coronarography of the venous sinus and in selected veins
previous occlusion of the balloon "over wire" for 8 to 10
minutes. Median number of mononuclear and CD34+ cells infused
were 7.34*108 and 1.97*107 respectively
in a median volume of 40 ml (range 40-50). Cell infusion was
performed under a pressure of 2-4 atmospheres.
During and
after the procedures no arrhythmias or increase in enzymes or
haemodinamic changes were observed. After a median time of 21
days ABMMC led to significant relief of angina symptoms and
improvement in functional class. By week +4 all patients
improved their contractibility in previously hypokinetic
sectors. By 90 to 150 days gamma studies demonstrated a
reduction in total perfusion defects size more than 10%.
Median EF improved significantly after procedure to 49.5%
(range 34-69, p=0,001) and nitrates requirement was reduced at
this point.
Unselected ABMNC transplantation by PRST is
feasible and safe and it allows to infused large volume of
cells in quite poor irrigated coronary vessels. This study
suggests the potential improvement of symptoms, functional
capacity, myocardial perfusion and contractility of ABMNC
transplantation in chronic coronary
patients.
