Rationale Two categories of cardiac stem cells (CSCs) with predominantly myogenic (mCSCs) and vasculogenic (vCSCs) properties have been characterized in the human heart. However, it is unknown whether functionally-competent CSCs of both classes are present in the myocardium of patients affected by end-stage cardiac failure, and whether these cells can be harvested from relatively small myocardial samples. Objective To establish whether a clinically relevant number of mCSCs and vCSCs can be isolated and expanded from endomyocardial biopsies of patients undergoing cardiac transplantation, or LVAD implantation. Methods and Results Endomyocardial biopsies were collected with a bioptome from the right side of the septum of explanted hearts or the apical LV core at the time of LVAD implantation. Two-five biopsies from each patient were enzymatically dissociated and, after expansion, cells were sorted for c-kit (mCSCs), or c-kit and KDR (vCSCs) and characterized. mCSCs and vCSCs constituted 97% and 3% of the c-kit population, respectively. Population doubling time averaged 27 hours in mCSCs and vCSCs; 5×106 mCSCs and vCSCs were obtained in 28 and 41 days, respectively. Both CSC classes possessed significant growth reserve as documented by high telomerase activity and relatively long telomeres. mCSCs formed mostly cardiomyocytes, and vCSCs endothelial and smooth muscle cells. Conclusions The growth properties of mCSCs and vCSCs isolated from endomyocardial biopsies from patients with advanced heart failure were comparable to those obtained previously from larger myocardial samples of patients undergoing elective cardiac surgery.
Cardiovascular surgery for the repair or replacement of diseased heart valves has continually improved since its introduction in the early 1960s. Despite advances in prosthetic heart valve design, to date there is no valve that is comparable to the native human valve with respect to durability, risk of thrombosis, and overall hemodynamic function. Although bioprosthetic devices are similar to the native valve with respect to thrombogenicity, durability is a significant concern, particularly in younger patients. Approximately 45% of implanted bioprosthetic valves fail at 10 years. In contrast, mechanical prostheses have a significantly lower incidence of structural failure, with an implantation life of greater than 20 years, and are thus more often used for patients under the age of 65. Unfortunately, significant hemodynamic and thrombotic issues have yet to be resolved with the latest generation of mechanical valves. Thus, careful analysis of patient factors and valve-related complications must be considered when treatment of heart valve disease is offered to the patient. The purpose of this review is to discuss the current recommendations for surgical intervention for heart valve disease.
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