Autologous transplantation of bone marrow mononuclear stem cells by mini-thoracotomy in dilated cardiomyopathy

technique and early results

Authors

  • Renato Abdala Karam Kalil Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Daniele Ott Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Roberto Sant’Anna Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Eduardo Dias Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • João Pedro Marques-Pereira Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Andrés Delgado-Cañedo Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Nance Beyer Nardi Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • João Ricardo Michelin Sant’Anna Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Paulo Roberto Prates Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia
  • Ivo Nesralla Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

Keywords:

Dilated cardiomyopathy, Stem cells, Heart surgery, Heart failure, congestive, Cell transplantation

Abstract

CONTEXT AND OBJECTIVES: There are few studies concerning bone marrow mononuclear cell (BMMC) transplantation in cases of nonischemic dilated cardiomyopathy. This study describes a novel technique of BMMC transplantation and the results up to one year after the procedure. DESIGN AND SETTING: This was a case series to evaluate the safety and viability of the procedure, at Instituto de Cardiologia do Rio Grande do Sul. METHODS: Nine patients with symptomatic dilated cardiomyopathy, functional class III/IV and left ventricular ejection fraction (LVEF) < 35% received BMMC (9.6 ± 2.6 x 107 cells) at 20 sites in the ventricular wall, by means of thoracotomy of length 5 cm in the fi fth left intercostal space. Echocardiograms and nuclear magnetic resonance (NMR) were performed. RESULTS: There were no major complications. The functional class results for the fi rst six patients (preoperatively and at two, four, eight and twelve-month follow-ups, respectively) were: [IV-2, III-4] to [I-5, II-1] to [I-3, II-3] to [I-2, II-3] and [I-2, II-3]. Echocardiograms showed LVEF: 25.9 ± 8.2; 32.9 ± 10.4; 29.4 ± 7.2; 25.1 ± 7.9; 25.4 ± 6.8% (p = 0.023); and % left ventricular (LV) fi ber shortening: 12.6 ± 4.4; 16.4 ± 5.4; 14.3 ± 3.7; 12.1 ± 4.0; 12.2 ± 3.4% (p = 0.021). LV performance variation seen on NMR was non-signifi cant. CONCLUSION: Intramyocardial transplantation of BMMC in dilated cardiomyopathy cases is feasible and safe. There were early improvements in symptoms and LV performance. Medium-term evaluation revealed regression of LV function, although maintaining improved functional class.

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Author Biographies

Renato Abdala Karam Kalil, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD, PhD. Professor at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA), Porto Alegre, Rio Grande do Sul, Brazil.

Daniele Ott, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD. Postgraduate student at Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Roberto Sant’Anna, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD. Medical doctor at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Eduardo Dias, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD. Postgraduate student at Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

João Pedro Marques-Pereira, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD, PhD. Professor at Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Andrés Delgado-Cañedo, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

PhD. Geneticist and Researcher at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Nance Beyer Nardi, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

BSc, PhD. Professor at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre; and Researcher in Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

João Ricardo Michelin Sant’Anna, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD, PhD. Professor at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Paulo Roberto Prates, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD. Cardiovascular surgeon at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre, Rio Grande do Sul, Brazil.

Ivo Nesralla, Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia

MD, PhD. Professor at Instituto de Cardiologia do Rio Grande do Sul (IC-RS), Fundação Universitária de Cardiologia (FUC), Porto Alegre, Rio Grande do Sul, Brazil.

References

Dimmeler S, Zeiher AM, Schneider MD. Unchain my heart: the scientific foundations of cardiac repair. J Clin Invest. 2005;115(3):572-83

Scorsin M, Hagège A, Vilquin JT, et al. Comparison of the effects of fetal cardiomyocyte and skeletal myoblast transplantation on postinfarction left ventricular function. J Thorac Cardiovas Surg. 2000;119(6):1169-75.

Tomita S, Li RK, Weisel RD, et al. Autologous transplanta- tion of bone marrow cells improves damaged heart function. Circulation. 1999;100(19 Suppl):II247-56.

Nagaya N, Kangawa K, Itoh T, et al. Transplantation of mesen- chymal stem cells improves cardiac function in a rat model of dilated cardiomyopathy. Circulation. 2005;112(8):1128-35.

Yoo KJ, Li RK, Weisel RD, Mickle DA, Li G, Yau TM. Autolo- gous smooth muscle cell transplantation improved heart function in dilated cardiomyopathy. Ann Thorac Surg. 2000;70(3):859-65.

Strauer BE, Brehm M, Zeus T, et al. Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans. Circulation. 2002;106(15):1913-8.

Stamm C, Westphal B, Kleine HD, et al. Autologous bone- marrow stem-cell transplantation for myocardial regeneration. Lancet. 2003;361(9351):45-6.

Perin EC, Dohmann HF, Borojevic R, et al. Improved exercise capacity and ischemia 6 and 12 months after transendocardial injection of autologous bone marrow mononuclear cells for ischemic cardiomyopathy. Circulation. 2004;110(11 Suppl 1): II213-8.

Joseph J, Rimawi A, Mehta P, et al. Safety and effectiveness of granulocyte-colony stimulating factor in mobilizing stem cells and improving cytokine profile in advanced chronic heart failure. Am J Cardiol. 2006;97(5):681-4.

Vilas-Boas F, Feitosa GS, Soares MB, et al. [Early results of bone marrow cell transplantation to the myocardium of patients with heart failure due to Chagas disease]. Arq Bras Cardiol. 2006;87(2):159-66.

Trainini JC, Lago NE, Alvarez M, et al. Mononuclear bone marrow stem cells implant as an alternative treatment in non- ischemic dilated cardiomyopathy. J Am Coll Cardiol. 2006;47(4 Suppl A):A80. [abstract].

Meyer GP, Wollert KC, Lotz J, et al. Intracoronary bone marrow cell transfer after myocardial infarction: eighteen months’ fol- low-up data from the randomized, controlled BOOST (BOne marrOw transfer to enhance ST-elevation infarct regeneration) trial. Circulation. 2006;113(10):1287-94.

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Published

2008-03-03

How to Cite

1.
Kalil RAK, Ott D, Sant’Anna R, Dias E, Marques-Pereira JP, Delgado-Cañedo A, Nardi NB, Sant’Anna JRM, Prates PR, Nesralla I. Autologous transplantation of bone marrow mononuclear stem cells by mini-thoracotomy in dilated cardiomyopathy: technique and early results. Sao Paulo Med J [Internet]. 2008 Mar. 3 [cited 2025 Mar. 9];126(2):75-81. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1949

Issue

Vol. 126 No. 2 (2008)

Section

Original Article

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