The immediate results of simultaneous surgical correction of complex heart disease with concomitant atrial fibrillation immediate effects of isolated transmyocardial laser revascularization procedures combined with intramyocardial injection of autologous bone marrow stem cells in patients with terminal stage of coronary artery disease

Abstract

Aim -to reveal the immediate results of the transmyocardial laser revascularization (TMLR) using CO 2 -laser along with the intramyocardial injections of autologous bone marrow stem cells (ABMSC) in patients with end-stage coronary lesions who cannot be completely revascularized with either percutaneous catheter intervention (PCI) or coronary artery bypass graft surgery (CABG). Materials and Methods -There were 20 patients with coronary artery disease (CAD) (mean age 55.4±8.6 years; data presented as mean with standard deviation -M±SD) enrolled in this prospective observational study. 90% were men. All were in angina NYHA class III. Arterial hypertension was presented in 90%, peripheral atherosclerosis in 60%. Other 60% of the patients were post-myocardial infarction, 70% were current smokers and the mean SYNTAX Score was 45.7±12.4. All patients had normal left ventricular ejection fraction and volumes calculated echocardiographycally. Around the zone of CO 2 -laser impact were injected ABMSC concentrate 200 μl per injection. Results -All surgeries done off-pump via left-sided anterolateral thoracotomy approach and CO 2 -laser with the mean duration of 114±41 minutes. Magnetic resonance imaging data was compared to the left ventricle (LV) wall segments to perform the laser holes. A sign of transmural perforation was the blood jet from the holes in the LV wall. We executed 24±5 perforations and injected 91.5 (67, 115) mln of ABMSC (data presented as median with interquartile range) per patient. Perforations performed on the lateral, anterior and posterior LV walls in 95%, 85% and 45% respectively and on the apex in 60%. The number of the holes did not prolong the time of the surgery (r=-0.09; Spearman correlation). Three (15%) patients had non-fatal complications in the early postoperative period. There was no correlation between these complications and the baseline clinical characteristics or intraoperative parameters. Mortality was 0%. Length of the intensive care unit stay was 1 day and total hospital stay was 6.7±0.7 days (M±SD). Conclusions -TMLR with intramyocardial autologous stem cells injections in patients with end-stage CAD is safe. This procedure can be done in the most severe group of patients who cannot be completely revascularized with either PCI or CABG surgery. Futher investigation is needed to assess the effectiveness of the procedure.Keywords: coronary artery disease, transmyocardial laser revascularization, CO 2 -laser, autologous stem cells bone marrow.Cite as Bockeria LA, Bockeria OL, Petrosyan AD, Shvartz VA, Donakanyan SA, Biniashvili MB. Immediate effects of isolated transmyocardial laser revascularization procedures combined with intramyocardial injection of autologous bone marrow stem cells in patients with terminal stage of coronary artery disease.