Biologically based myocardial regeneration: is there a role for the surgeon?

Despite advances in medical, percutaneous, and surgical treatment, there is an increasing burden of ischemic cardiovascular disease and heart failure. Over the past decade, a large number of preclinical and clinical studies have evaluated various biologic agents to treat these diseases.

Although the safety and feasibility of growth factor therapy, using vascular endothelial growth factors and fibroblast growth factors, for myocardial angiogenesis has been well established in a number of clinical trials, their ability to induce clinically significant improvements in symptoms remains uncertain. Numerous candidates have been proposed for cell-based therapies to improve myocardial perfusion and function and have demonstrated efficacy in preclinical studies. These cell types include skeletal myoblasts, bone-marrow derived cells, endothelial progenitors, and mesenchymal stem cells. Early clinical trials have demonstrated feasibility of cell harvest and implantation.

Biologic myocardial regeneration is a new and rapidly evolving area for the treatment of cardiovascular disease. Translation of these biologic entities into clinically useful therapeutic agents will require a better mechanistic understanding of their effects on the myocardium and the coronary circulation, optimization of delivery techniques, and systematic evaluation in large, randomized, placebo-controlled studies.