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Abstract

Cell therapy plus transmyocardial laser revascularization: a proposed alternative procedure for refractory anginaComments to the study "Cell therapy plus transmyocardial laser revascularization: a proposed alternative procedure for refractory angina", from the author PhD Luiz Dallan, presented at the 34th Congress of the Brazilian Society of Cardiovascular Surgery and published in the Brazilian Journal of Cardiovascular Surgery (2008;23[1]) Analyzing international literature on the topic of cell therapy, I noted the rarity of this association of techniques, and I found only two studies from the INCOR group, with the case report of the first patient of this series, from 2005 [1] -the same case presented in a study in which cell therapy was used together with conventional or transmyocardial laser revascularization from 2006 [2] -and one case by H.M. Klein from the University of Dusserdolf, Germany, 2004 [3], where the technique was used in two patients. In all studies, improvement in left ventricular contractility was reported, proving to be another method of coronary revascularization, using either the antigen from CD 34 + hematopoietic progenitor cells, as in the INCOR'studies, or the CD 133 + , as in the Klein' study [3], and concluded by Kobari [4] when he compared CD 133 + with CD 34 + . The technique of transmyocardial laser revascularization (TLMR) is already well established as an option for a cardiac procedure for coronary revascularization, showing an improvement in the angina functional class in most of the patients, according to the Canadian Cardiovascular Society [5]. The technique of using CD133 + stem cells is also already established as an alternative for patients for whom techniques of conventional coronary revascularization are not susceptible to indication, as proven by H.M. Klein in isolated uses [6]. The combined use of the two techniques performed by Klein in 2004 is now proven by this study. The study yielded excellent results from applying these techniques in nine patients: there was no mortality associated with the disease being studied. However, in the study, the authors do not offer any indirect measurements of improvement of the general situation (either through quality life questionnaires, or through measurement of the left ventricle ejection fraction,) but only to indirect data from angina classification and the ischemic index. O uso conjunto das duas técnicas realizado por Klein, em 2004, está agora comprovado com este trabalho ao obter um excelente resultado quando de sua aplicação em nove pacientes, sem mortalidade associada á doença em estudo. No entanto, os autores não fazem referência no trabalho tanto a medidas indiretas mensuráveis de melhora do quadro geral, quer seja através de questionários de qualidade de vida, quer seja através da medida da fração de ejeção de ventrículo esquerdo e apenas a dados indiretos de classificação de angina e índice isquêmico. However, some authors [7] highlight the fact that the use of these techniques should be performed only in patients...