Transmiocardial laser revascularization in combination with bone marrow cells implantation in the ischemic heart disease surgery: long-term results

摘要

Background ― The problem of incomplete myocardial revascularization for diffuse and distal lesions of the myocardium is still relevant. We assessed the clinical and instrumental long-term results of autologous bone marrow cell (BMC) implantation in laser channels in ischemic heart disease with diffuse and distal coronary disease.Material and Methods ― In 2007 and 2008, 35 ischemic heart disease (IHD) patients with diffuse and distal coronary disease during coronary artery bypass grafting (CABG) underwent BMC implantation in laser channels in the clinic of National Medical Research Center n.a. E.N. Meshalkin (Novosibirsk, Russia). This group was named as “BMC group”. The Control group consisted of 29 patients who underwent only CABG. Clinical and instrumental assessment of the method's effect was carried out at two weeks, six months, and six years after surgery. Long-term follow-up was performed only in 30 patients from the BMC group.Results ― After six months postoperatively, the severity of angina and heart failure based on Canadian Cardiovascular Society functional class (CCS FC) and the New York Heart Association functional class (NYHA FC) was significantly less in the BMC group than in the Control group (p=0.03 for CCS FC and p=0.04 for NYHA FC). Six years after surgery angina and heart insufficiency were at the same level. According to perfusion scintigraphy, there was a slight decrease of stable perfusion defects (SPD) in the immediate postoperative period and a more pronounced SPD reduction at six months after surgery. In BMC group, the SPD value before surgery was 18.4 (12.8, 22.4) %, 16.1 (11.6, 19.3) % at two weeks after the operation, and 13.2 (8.5, 17.3) % after six months. In the long-term period (six years), SPD was 11.9 (8.7, 14.2) % (p=0.047). A similar pattern was observed in the analysis of transient perfusion defects: baseline was 29.3 (22.1, 34.1) %, 13.1 (11.2, 16.5) % at six months, and 17.0 (14.3, 20.5) % in the long term (p=0.047). Left ventricular ejection fraction before surgery was 51 (49, 57) %, 54 (49, 57) % at two weeks after the operation, 54 (49, 58) % at six months, and 52 (49, 58) % after six years. The dynamics are not statistically significant (p=0.068).Conclusion ― Autologous BMC implantation in laser channels is an effective method of IHD surgical treatment if it is impossible to perform direct myocardial revascularization. The indirect revascularization effect is formed in the first six months after surgery and remains at the same level for six years.