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Ann Thorac Surg 2004;78:1808-1812
© 2004 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, Milano, Italy
b Department of Cardiovascular Gene and Cell Therapy Clinical Program, Centro Cardiologico Monzino IRCCS, Milan, Italy
c Division of Haematology-Oncology, European Institute of Oncology IRCCS, Milan, Italy
d Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy
Accepted for publication September 8, 2003.
* Address reprint requests to Dr Pompilio, Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Via Parea 4, Milan 20138, Italy
giulio.pompilio{at}ccfm.it
PURPOSE: Bone-marrow and peripheral blood-derived stem cells can be used as stimulators of myogenesis and angiogenesis. We describe an original technique for collection and surgical intramyocardial injection of peripheral blood-derived stem cells.
DESCRIPTION: Stem cells are mobilized from the bone marrow by means of subcutaneous administration of Lenogastrim (Granocyte 34 [Aventis Pharma, Milan, Italy]) for 4 days. Then the day before the operation the peripheral blood-derived stem cells are collected by means of apheresis and processed in order to obtain the CD 133+ cells. Cells are injected into the myocardium in a beating heart in order to induce angiogenesis locally or myogenesis, or both. When necessary, off-pump coronary artery bypass grafting is previously accomplished.
EVALUATION: Thus far we have investigated 4 patients (3 patients who have received off-pump peripheral blood stem cell injection and coronary bypass grafting through median sternotomies, and 1 patient who underwent cell transplant alone through a minimally-invasive transdiaphragmatic approach). No complications were noted at a mean of 4 months after surgery.
CONCLUSIONS: This novel method of peripheral bone marrow stem cell collection and intramyocardial injection seems to be safe, feasible, and reproducible. However, there is need of further evidence to definitely assess safety issues and clinical results.
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