[Transcatheter cell therapy of heart failure: state of the art]

The progressive loss of cardiomyocytes by different injuries (first of all by ischemia), associated with an insufficient endogenous repair process, is one of the main factors of heart failure development, a real health problem in western countries. In the last decade, cell transplantation in the heart of stem cells with myogenic and angiogenic potential, by intrinsic capability of cellular differentiation and paracrine favorable effects, represents a promising therapy for heart failure, producing a real myocardial regeneration. Early clinical results have been obtained from phase I studies with autologous adult stem cells such as skeletal myoblasts and bone marrow mononuclear cells. The easy cellular availability, the lack of need for immunosuppression and the absent likelihood of tumor formation after cell transplantation are important advantages of these cells, which allow to overcome the apparent ethical dilemma associated with the use of fetal/embryonic cells. Three percutaneous cell delivery methods have been added to the initial surgical transepicardial approach: transendocardial, intracoronary and coronary transvenous injection. The aim of this review was to describe advantages, limitations and techniques about each transcatheter delivery approach to cardiac tissue repair, in the light of current knowledge, investigating possible application fields in different left ventricular dysfunction settings.