An orthotopic heart transplant remains the gold standard treatment for patients with end-stage heart failure. Despite significant developments and the widespread use of durable mechanical circulation support, a small number of patients will be considered for a heart retransplant. In this video tutorial, we describe the strategy and technique for patients who have already received an orthotopic heart transplant and who undergo a cardiac retransplant with a modified bicaval anastomosis technique.

he long-term outcomes of cellular cardiomyoplasty in patients with ischemic cardiac dysfunction were studied. The results of treatment of 45 patients aged 46–70 years, mean age is (56.8±19.7) years, who were hospitalized in the Emergency and Reconstmctive Cardiac Surgery Department of the "V.K. Gusak Institute of Emergency and Reconstmctive Surgery of NAMS of Ukraine" from 2007 to 2013 were analyzed. It was established that the transplantation of autologous mesenchymal bone marrow stem cells using the navigation system is a safe and effective procedure, that helps to increase the survival rates up to 35 (18–61) months compared to 12 (0.72-50.0) months in the group of pharmacological therapy (p value = 0.033). Also the reduction of mortality 36 months after the stem cells injection to 13.3% compared to 46.7% in the group of pharmacological treatment in the same terms was observed. To achieve the maximum effect of treatment, it is reasonable to repeat the procedure of autologous mesenchymal bone marrow stem cells transplantation 1 year later after the first procedure. Endomyocardial implantation of autologous mesenchymal bone marrow stem cells improves basic dimensions of life quality: physical functioning, pain intensity, usual activity and social functioning regardless of the initial severity of ischemic dysfunction. Keywords: stem cells, cardiomyoplasty, heart failure, refractory angina.

Objective. Improvement of the treatment results in patients with refractory angina, complicated by the heart insufficiency, using new methods of correction of the heart pumping function elaborated. Materials and methods. Clinical investigation was performed, basing on retro- and prospective analysis of the treatment results in 156 patients: efficacy of myocardial remodeling was studied, using mesenchymal stem cells in patients, suffering refractory angina. For determination of the cellular therapy efficacy a navigation system NOGA XP was applied. Results. There were presented the results of investigation of efficacy of intravenous injections of autologous mesenchymal stem cells to patients, suffering refractory angina, complicated by lowering of the heart pumping function, and immediate results of cardiomyoplasty using stem cells as well. For the first time a navigation system NOGA XP for determination of myocardial hibernation zones was applied in patients, suffering refractory angina. Also, using navigation system NOGA XP, the results of cellular cardiomyoplasty were obtained, while comparing electro-mechanical schemes before and after cellular therapy. Conclusion. There was established the improvement of indices of the heart pumping function and the patients’ quality of life.

The first clinical studies dedicated to the use of autological mesenchymal stem сells(MSCs) for the treatment of angina by means of their intravenous and transendocardialinjection is carried out in State Institution «Institute of Urgent and Recovery Surgerynamed after V.K. Gusak of National Academy of Medical Science of Ukraine» since 2007.The effectiveness of autological mesenchymal stem cells (MSCs) was researched in 60patients, and it was established that injection of 50 million of cells per a person withrefractory angina is an effective and a safe method of treatment. The results of clinicalresearch have shown that the delivery of MSCs to the lesion provides restoring ofmyocardial function and influences on the left ventricular remodeling.Objective – to substantiate the effectiveness of autological MSCs in the treatment ofrefractory angina.Material and methods. The results of examination, treatment and observation of 60patients with refractory angina (52 men and 8 women aged from 46 to 70 years) since2007 to 2012 are performed in the article.Results. We obtained the following data while studying of the dynamics of left ventricularend diastolic volume (LVEDV), which is a prognostic factor of the course of heart failure(HF). The decrease of LVEDV from 248.5 ± 22.3 to 194.3 ± 26.4 ml was observed inthe group of patients 3 months later after endocardial injection. This rate was stable 6months later after an injection, but lower than the initial one (p value > 0.05). A similartrend was observed in the group of intravenous injection . LVEDV decreased from 244.1± 24.3 to 193.4 ± 18.9 ml within 3 months and remained stable up to 6 months but lowerto the rate that was observed before the treatment with a trend to increasing to the initiallevel. Ultrasound studying of the left ventricular ejection fraction (LVEF) in patients of transendocardial injection of cell transplant showed an increasing of LVEF from 41.3 ±3.2 to 49.3 ± 4.6% 3 months later after the procedure and it was stable up to 6 months ofthe posttransplant period. LVEF is also increased in the group of intravenous transplantadmission (from 33.8 ± 3.6 to 42.8 ± 4.8%) after procedure, with its gradually decreasingin terms of 3 months, LVEF approaches the starting values up to 6 months after celltransplantation.Conclusions. The received clinical data have shown that MSCs facilitate the restoringof mechanical myocardial function and influence left ventricular remodeling aftertheir admission to the lesion zone. This effect has been confirmed according to cardiacechocardiography, treadmill-test, electromechanical mapping of the LV. The positiveeffect was remaining for 6 months. The received data allows to recommend the clinicaluse of biotechnology in ischemic heart disease treatment.

Purpose is to study the effectiveness of intracoronary introduction application of mesenchymal stem cells (MSC’s) in refractory angina pectoris.Material and methods. The study was based on the results founded by the investigation, treatment and dynamic follow-up results of 30 patients with refractory angina pectoris who underwent the stationary therapy in the department of Urgent and Recovery Cardiac surgery of SI «Institute of Urgent and Recovery Surgery named after V.K. Gusak of NAMS of Ukraine» from 2007 till 2014. We formed 2 groups; each of them included 15 patients: in the first group (a control one), the patients received only medicamental therapy; the second group received intracoronary administration of autologous MSC’s. According to NYHA (New York Heart Association) classification, all the patients had II-IV functional class of chronic heart failure (CHF). All the patients earlier went through the different revascularization surgeries. Mesenchymal autologous bone marrow stem cells were received according to the standard method in the laboratory of cellular and tissue cultivation of SI «Institute of Urgent and Recovery Surgery named after V.K. Gusak of NAMS of Ukraine». Using the local anesthesia with catheter application in the coronary vessel mouth was implemented a transplant in the dose of 10 million cells.Results. During the control examination, a clinical improvement was observed in all the patients; it was expressed in the quality of life increase according to the Minnesota Questionnaire (MLHFQ); in a decrease of heart failure grade according to NYHA, and tolerance growth to physical exercise during the treadmill test. The maximal effect, by the way, was developed in month and had been holding on during the 9-12 months. Thus if the quality of life before applying the transplantation of autologous MSC was 58+1,8 points; after the 3 months this rate was 32±2,2 points (by p<0,05); but after the I year, it was 37±2,1 points and was progressively decreased in the future. During the ultrasound imaging in the first group was mentioned decrease of left ventricle (LV) ejection fraction (EF) till 23,2±5,2% during the whole study; in the second group, it was observed an EF increase from 31,2±7,1 to 37,4±5,2% by p<0,05 and to the deadline of 6 months it began to decrease. In this period of time the patients reduced the doses of taken medicines; it was mentioned tolerance intensification to the physical exercises that we approved with the help of treadmill test. During the cardiac mapping with the help of navigation system CARTO XP we observed that in 6 months the amplitude of unipolar signal increased from 7,8-8,7 MB to 9,0-9,4 MB in the front-lateral zone; and from 5,3-12,0 to 7,9-14,1 MB in the b posteroseptal correspondingly; it tells about the improvement of electromechanical association and improvement of working function as well as myocardium perfusion. In three years during the control investigation, it was mentioned a negative dynamics in comparison with the baseline results. Conclusions. As we see, the first experience of intracoronary introduction of autologous MSC in patients with refractory angina pectoris showed the raise of myocardium functional reserve that was reflected in the improvement of life quality; reduction of antianginal agent doses; raise of LV EF; as well as in the amplitude of unipolar myocardium signal increase in the MSC introduction zone.