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Intramyocardial bone marrow stem cell transplantation during coronary artery bypass surgery: a meta-analysis
Peter Donndorf1, Guenther Kundt, Alexander Kaminski
1Department of Cardiac Surgery, University of Rostock, Rostock, Germany. peter.donndorf@med.uni-rostock.de
Insights
Bone marrow stem cell transplantation during coronary artery bypass grafting significantly improves left ventricular ejection fraction in patients with chronic ischemic heart disease. This stem cell therapy appears safe, with no significant increase in adverse cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Stem Cell Biology
Background:
- Chronic ischemic heart disease often leads to impaired left ventricular function.
- Intramyocardial bone marrow stem cell transplantation is being explored as a therapeutic option.
- Combining stem cell therapy with coronary artery bypass grafting (CABG) may enhance outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy and safety of intramyocardial bone marrow stem cell transplantation during CABG.
- To evaluate the impact of this combined therapy on left ventricular function.
- To assess the incidence of adverse cardiovascular events.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials and cohort studies.
- Searched databases: PUBMED, MEDLINE, Cochrane Controlled Trials Register, and ClinicalTrials.gov (inception to May 2009).
- Included six relevant studies.
Main Results:
- Significant improvement in left ventricular ejection fraction (5.40%) in the stem cell group compared to controls (P = .009).
- A trend towards improved left ventricular end-diastolic volume in the stem cell group (P = .13).
- No significant difference in major adverse cardiovascular events, including ventricular arrhythmia (P = .913).
Conclusions:
- Intramyocardial bone marrow stem cell transplantation combined with CABG shows promise for improving cardiac function in chronic ischemic heart disease.
- The surgical application of bone marrow stem cell transplantation appears to be a safe procedure.
- Further research may solidify its role in cardiovascular regenerative medicine.
Objective:
Experimental and clinical studies have suggested that intramyocardial bone marrow stem cell transplantation combined with coronary artery bypass grafting might improve left ventricular function in the setting of chronic ischemic heart disease. We therefore conducted a systematic review and meta-analysis of available publications regarding the efficacy and safety of intramyocardial bone marrow stem cell transplantation during coronary artery bypass grafting.
Methods:
The databases PUBMED, MEDLINE, Cochrane Controlled Trials Register, and ClinicalTrials.gov (all from their inception to May 2009) were searched for randomized controlled trials and cohort studies of intramyocardial bone marrow stem cell transplantation during coronary artery bypass grafting to treat ischemic heart disease. Six studies were included.
Results:
Compared with control groups, the bone marrow stem cell transplantation group showed a significant improvement of left ventricular ejection fraction from baseline to follow-up (5.40%; 95% confidence interval, 1.36-9.44; P = .009). Moreover, the overall change of left ventricular end-diastolic volume from baseline to follow-up favored the bone marrow stem cell therapy group (9.55 mL; 95% confidence interval, -2.82 to 21.92; P = .13). Major adverse cardiovascular events, including ventricular arrhythmia and the composite of other cardiovascular events, were not significantly different between the bone marrow stem cell therapy group and controls (relative risk for ventricular arrhythmia = 0.951; 95% confidence interval, 0.389-2.325; P = .913; relative risk for cardiovascular event = 1.134; 95% confidence interval, 0.28-4.6; P = .86).
Conclusions:
Clinical evidence suggests that intramyocardial bone marrow stem cell transplantation in combination with coronary artery bypass grafting is associated with improvements of functional parameters in patients with chronic ischemic heart disease. Furthermore, surgical intramyocardial bone marrow stem cell transplantation seems to be safe.
