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Published on: August 13, 2017
Preoperative mobilization of bone marrow-derived cells followed by revascularization surgery: early and long-term
Guglielmo Mario Actis Dato1, Fabrizio Sansone, Paola Omedé
1Division of Cardiac Surgery, Mauriziano Umberto I Hospital of Turin, Turin, Italy.
Insights
This study combined bone marrow stem cell mobilization with coronary artery bypass grafting in 15 patients, showing safe short-term outcomes. Further research is needed to confirm long-term benefits of this regenerative approach for heart disease.
Area of Science:
- Cardiovascular Surgery
- Regenerative Medicine
- Stem Cell Therapy
Background:
- Coronary artery disease (CAD) and its complications pose significant global health challenges.
- Myocardial regeneration using mobilized stem cells offers a potential therapeutic pathway.
- Bone marrow-derived stem cells (BMCs) can be mobilized to peripheral blood (PB) using cytokines.
Observation:
- The study involved 15 patients undergoing coronary artery bypass grafting (CABG) and/or mitral valve surgery, with ventricular remodeling and trans-myocardial punctures.
- Peak circulating BMCs were observed between postoperative days 4 and 6.
- No in-hospital mortality (0-30 days) was recorded, with a median ICU stay of 2 days and a median hospital stay of 10.5 days.
Findings:
- The combination of BMC mobilization and CABG was safely performed in this patient cohort.
- Two mid-term sudden deaths occurred at postoperative days 32 and 45.
- Patients were discharged in good clinical condition.
Implications:
- This combined approach appears safe for treating advanced heart conditions.
- Larger prospective studies are required to validate the efficacy of BMC mobilization combined with CABG.
- Future research should compare cytokine therapy, myocardial perforation, and combination strategies.
Introduction:
Coronary artery disease (CAD), along with its main complications such as acute myocardial infarction (AMI) and congestive heart failure (CHF), remains a serious worldwide problem and affects many patients despite the improvement of medical treatment. The possibility of the replacement of the infarcted areas by the re-generation of the myocardial cells has been long discussed and the mobilization of the stem cells from bone marrow (BMCs) to the peripheral blood (PB) induced by cytokines, represents a potential pathway to activate the regenerative process.
Patients And Methods:
We describe BMC mobilization and direct/indirect revascularization in 15 patients operated on for coronary artery bypass grafting (CABG) and/or mitral valve surgery and/or ventricular remodeling combined to multiple trans-myocardial punctures (Sen technique) in ungraftable non-viable fibrotic areas.
Results:
Peak values of circulating BMCs were recorded between day +4 and day +6. We had no in-hospital (0-30 days) mortality. All the patients were discharged from the ICU after a median period of 2 days while the in-hospital length of stay was 10.5+4.2 days (range 7-21) and all patients were discharged in good clinical condition. There were two sudden deaths over the mid-term, at postoperative day (POD) 32 and 45 respectively.
Conclusions:
Our study suggests that the combination of BMC mobilization and CABG may be safely performed. However, considering the small series, final conclusions about the benefit of this procedure must await a larger prospective study comparing the role of cytokines alone, myocardial perforation, and the combination of both.
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