• Sao Paulo Med J · Mar 2008

    Autologous transplantation of bone marrow mononuclear stem cells by mini-thoracotomy in dilated cardiomyopathy: technique and early results.

    • Renato Abdala Karam Kalil, Daniele Ott, Roberto Sant'Anna, Eduardo Dias, João Pedro Marques-Pereira, Andrés Delgado-Cañedo, Nance Beyer Nardi, João Ricardo Michelin Sant'Anna, Paulo Roberto Prates, and Ivo Nesralla.
    • Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande do Sul, Brazil. kalil@cardiologia.org.br
    • Sao Paulo Med J. 2008 Mar 6; 126 (2): 758175-81.

    Context And ObjectivesThere are few studies concerning bone marrow mononuclear cell (BMMC) transplantation in cases of nonischemic dilated cardiomyopathy. This study describes a novel technique of BMMC transplantation and the results up to one year after the procedure.Design And SettingThis was a case series to evaluate the safety and viability of the procedure, at Instituto de Cardiologia do Rio Grande do Sul.MethodsNine patients with symptomatic dilated cardiomyopathy, functional class III/IV and left ventricular ejection fraction (LVEF) < 35% received BMMC (9.6 +/- 2.6 x 107 cells) at 20 sites in the ventricular wall, by means of thoracotomy of length 5 cm in the fifth left intercostal space. Echocardiograms and nuclear magnetic resonance (NMR) were performed.ResultsThere were no major complications. The functional class results for the first six patients (preoperatively and at two, four, eight and twelve-month follow-ups, respectively) were: [IV-2, III-4] to [I-5, II-1] to [I-3, II-3] to [I-2, II-3] and [I-2, II-3]. Echocardiograms showed LVEF: 25.9 +/- 8.2; 32.9 +/- 10.4; 29.4 +/- 7.2; 25.1 +/- 7.9; 25.4 +/- 6.8% (p = 0.023); and % left ventricular (LV) fiber shortening: 12.6 +/- 4.4; 16.4 +/- 5.4; 14.3 +/- 3.7; 12.1 +/- 4.0; 12.2 +/- 3.4% (p = 0.021). LV performance variation seen on NMR was non-significant.ConclusionIntramyocardial transplantation of BMMC in dilated cardiomyopathy cases is feasible and safe. There were early improvements in symptoms and LV performance. Medium-term evaluation revealed regression of LV function, although maintaining improved functional class.

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