Procedural circulatory support-enabled intracoronary cell delivery in advanced dilated cardiomyopathy.

Advanced heart failure due to dilated cardiomyopathy (DCM) has limited treatment options. Although intracoronary autologous cell therapy may improve cardiac function, its use in patients with severe left ventricular dysfunction is limited by procedural risk. This exploratory study investigated whether temporary mechanical circulatory support with an Impella device could enable safer therapy delivery. Twenty patients with DCM and a left ventricular ejection fraction (LVEF) of ≤35% received granulocyte colony-stimulating factor pretreatment followed by Impella-supported intracoronary infusion of autologous bone marrow mononuclear cells. The procedure was feasible, well tolerated, and not associated with major complications. After three months, mean LVEF increased by 2.9%, with numerically greater gains in those with more severe baseline impairment. Participants also experienced symptomatic, exercise capacity, and quality of life improvements. Changes in microvascular function and circulating soluble receptor for advanced glycation end-products (sRAGE) suggested potential mechanistic pathways. As a single-arm study, these findings are hypothesis generating and support further evaluation in randomized controlled trials.