Abstract
6667 Background: BM stem cells have ability to differentiate into cardiac myocytes, smooth muscle cells and endothelial cells when injected into the myocardium after ischemic injury. Methods:21 patients of myocardial infarct (confirmed on stress thallium SPECT and trans-thoracic echocardiography) undergoing CABG (coronary artery bypass grafting) were studied. During CABG, BM was harvested in heparinised syringes by sternal aspirate. BM mononuclear cells (MNC) were separated using Ficoll density gradient centrifugation. At the end of the CABG, MNC were injected in and around the region of myocardial scar in 19 patients. In 2 patients stem cells were implanted through infarct related artery by coronary angioplasty. Results:The mean age of the 21 patients was 50.57years (SD =7.07) with male: female ratio of 19:2. The mean volume of BM collected was 35.33ml (SD =8.6) with a cell count of 1.3 x 107/ml (SD =2 x107). Viability of the MNC was 99% (checked by Trypan blue dye exclusion test). The MNC morphology was also seen under the light microscope by Giemsa staining and the average percentage of MNCs was 89.28 (SD=1.7). CD 34+ cells were enumerated by flowcytometry in 5 patients only, and the mean count was 0.95% (SD = 0.54). The MNCs were finally suspended in normal saline and a mean of 38+9 infarct sites were injected with 0.25ml /site. The average number of cells injected per site was 3.2 x 106. There was no adverse effect of the procedure (immediate, in-hospital or at a mean follow-up of 5.9 months + 2.8 mo). Specifically, there were no deaths and no significant ventricular arrhythmias on 24 hour holter monitoring. Initial follow-up information is currently available for the first 8 patients. There was improvement in New York Heart Association functional class (from 2.67+0.82 to 1.5+ 0.55; p=0.02) and left ventricular ejection fraction (from 30+ 13% to 42+ 10%; p=0.04). Three and 6 months follow-up data (invasive and non-invasive) is being acquired. Conclusions:This pilot study has indicated the potential safe use of the hematopoietic stem cells for repair of myocardium. No significant financial relationships to disclose.
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