Effective combined off-pump surgical treatment and autologous bone marrow cell transplantation: a new alternative for patients with end-stage ischemic cardiomyopathy (Prapas' procedure).

OBJECTIVE

To propose an alternative method combined off-pump treatment of end-stage ischemic cardiomyopathy consisting of revascularization of ischemic areas, external reshaping of the left ventricle (LV) in order to restore near normal geometry and autologous bone marrow-derived mononuclear cell (BM-MNC) implantation.

METHODS

Forty- seven patients (mean age 58+/-8.9 years) underwent the above procedure. All patients were NYHA III-IV and four were transplantation candidates. They underwent standard laboratory evaluation, transthoracic echocardiography, dipyridamole thallium scintigraphy (DTS) and cardiac magnetic resonance imaging preoperatively and at 3rd, 6th and 12th months postoperatively. After revascularization and external LV reshaping, BM-MNCs were injected into predetermined peri-infarct areas.

RESULTS

Forty-five patients survived during a follow up period of 3-37 months. Ejection fraction improved from 21.7+/-7.4% to 30.6+/-6.9%, 36.5+/-4.3% and 37.7+/-4.2% at 3rd, 6th and 12th months, respectively. Left ventricular end-diastolic diameter was reduced from 66.1+/-4.9 mm to 62.6+/-3.9 mm, 60.5+/-2.9 mm and 59.3+/-4.2 mm respectively. Previously non-viable areas on DTS were found to contain viable tissue and MRI showed hypokinesia in previously akinetic areas. NYHA class improved to I-II. No significant arrhythmias were noted during the follow-up period. One patient died due to low cardiac output and one patient died due to septic shock.

CONCLUSIONS

Combined off-pump surgical treatment and autologous bone-marrow mononuclear cell transplantation for end-stage ischemic cardiomyopathy is safe and feasible and appears to improve the patients' functional status.