ONE YEAR FOLLOWUP OF COMBINED AUTOLOGOUS BONE MARROW DERIVED PROGENITOR CELL THERAPY AND TRANSMYOCARDIAL LASER REVASCULARIZATION FOR DIFFUSE NONGRAFTABLE CORONARY ARTERY DISEASE
INDRAPRASTHA APOLLO HOSPITAL, SARITA VIHAR ,MATHURA ROAD, New Delhi, India.
OBJECTIVE: Combined autologous bone marrow derived progenitor cell therapy along with transmyocardial laser revascularization (BMLR) is being done in addition to coronary artery bypass (CABG) in the patients with diffuse coronary artery disease at our institute for over an year. The initial data was encouraging and we present here the one year follow up data of this combined therapy for diffuse coronary artery disease.
METHODS: Patients with symptomatic multivessel, diffuse coronary artery disease with preserved ventricular function, who had at least one territory rendered as nongraftable by two independent surgeons, were included in the study after they signed the informed consent. All patients were subjected to 120 ml of bone marrow aspiration from the iliac crest, and stem cells were seprated using Harvest system. An effort was made to bypass all graftable vessels. Transmyocardial laser channels were created in the nongraftable area and stem cell injected around these channels using Phoenix system. All patients had contrast magnetic resonance imaging (MRI) scans before, six months and 1 year post surgery. Patients having completed 1 year follow up were included for analysis.
RESULTS: Eight patients completed 1 year follow up, 7 males, mean EF of 53.4%. Seven patients received an average of 2.2 grafts, 1 patient could not receive any grafts. There was no operative and hospital mortality. One year survival was 100%. Compared to baseline, patients (including the one with BMLR alone) improved NYHA Class (Mean 3.5+/-0.5 to 1.33+/- 0.5, p= 0.001). Six minute walk test: 250+/- 112.1 seconds to 360+/-10 seconds, p=0.01. One patient had recurrence of angina due to occlusion distal to the LAD graft and had to be reoperated. MRI showed improvement in perfusion in BMLR and Stem Cell areas.
CONCLUSIONS: These findings suggest that combined autologous bone marrow derived progenitor cell therapy and transmyocardial laser revascularization along with bypass grafting is an effective option for patients with diffuse coronary artery disease. Acute and one year results are encouraging in this small group of patients and indicate the need of a large randomized clinical trial to further confirm these observations.
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