Long-term Results of Isolated Transmyocardial Laser Revascularization Procedures Combined with Intramyocardial Injection of Autologous Bone Marrow Stem Cells in Patients with Diffuse Lesions of Coronary Arteries

Leo A. Bockeria ¹, Andrey D. Petrosyan ², Olga L. Bockeria ², Vladimir A. Shvartz ², Sergey A. Donakanyan ², Mikhail B. Biniashvili ¹, Artak Y. Ispiryan ²

¹ Scientific medical research center of cardiovascular surgery name of A. N. Bakulev, Moscow, Russia; ² Scientific medical research center of cardiovascular surgery name of A. N. Bakulev, Moscow, Russia;

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–A

Abstract

Objective

To asses long-termed results of Transmyocardial Laser Revascularization (TMLR) combined with intramyocardial administration of autologous bone marrow stem cells (ABMSC).

Methods

20 patients (90%-males) of mean age 58.4 ± 8.7 years old were involved in the study. Minnesota Living with Heart Failure Questionnaire (MLHF-Q), Seattle Angina Questionnaire (SAQ) which assessing the most important aspects of quality of life in patients with CHD were used with further comparison of results before surgery and in the current time. ECG, ECHO-CG data were assessed. End points included death, acute myocardial infarction, repeated revascularization, repeated hospitalizations due to CHD, acute cerebrovascular accident and effort angina functional class was assessed as well.

Results

Median follow up period was 54 (36; 83) months that is 4.5 years. The analysis of ECHO-CG data showed the absence of statistically significant changes of the parameters: EDD (р=0.967), ESD (р=0.204), EDV (р=0.852), ESV (р=0.125), LV EF (р=0.120).

The use of nitrates statistically significantly decreased: only 3 patients received this group of drugs in long-termed period.

Also significant positive dynamics was observed in angina functional classes. At baseline all patients had angina FC III; in long-termed period 3 patients had angina FC II, 11 patients – angina FC I, 6 patients had no angina.

Mortality, acute myocardial infarction and acute cerebrovascular accident were absent during follow up period. Although there were 2 cases of repeated revascularization.

During regression analysis only one parameter – SYNTAX score was outlined as it with high level of statistical significance was related to outcome repeated revascularization.

Conclusions

TMLR in combination with intramyocardial administration of ABMSC is the safe method allowing the achievement statistically significant antianginal effect and reduce of demand in nitrates that consequently improves the quality of life, frequency of hospitalization due to CHD.