Hybrid approach of ventricular assist device and autologous bone marrow stem cells implantation in end-stage ischemic heart failure enhances myocardial reperfusion

Abstract

We challenge the hypothesis of enhanced myocardial reperfusion after implanting a left ventricular assist device together with bone marrow mononuclear stem cells in patients with end-stage ischemic cardiomyopathy. Irreversible myocardial loss observed in ischemic cardiomyopathy leads to progressive cardiac remodelling and dysfunction through a complex neurohormonal cascade. New generation assist devices promote myocardial recovery only in patients with dilated or peripartum cardiomyopathy. In the setting of diffuse myocardial ischemia not amenable to revascularization, native myocardial recovery has not been observed after implantation of an assist device as destination therapy. The hybrid approach of implanting autologous bone marrow stem cells during assist device implantation may eventually improve native cardiac function, which may be associated with a better prognosis eventually ameliorating the need for subsequent heart transplantation. The aforementioned hypothesis has to be tested with well-designed prospective multicentre studies.

Percutaneous Fluoroscopic-Guided Endomyocardial Delivery in an Experimental Model of Left Ventricular Assist Device Support

“…In a recent report, mesenchymal precursor cells were injected intramyocardially at the time of LVAD implantation [8]. A major disadvantage of such an approach is that stem cell injections have to be timed with LVAD implantation.…”

“…Until today, there are very few reports of concomitant stem cell-based therapy and LVAD support for the treatment of heart failure [8,9]. Previous research of combining LVAD and stem cell therapy has focused on stem cell injections at Associate Editor Lorrie Kirshenbaum oversaw the review of this article Electronic supplementary material The online version of this article (doi:10.1007/s12265-015-9642-4) contains supplementary material, which is available to authorized users.…”

“…Previous research of combining LVAD and stem cell therapy has focused on stem cell injections at Associate Editor Lorrie Kirshenbaum oversaw the review of this article Electronic supplementary material The online version of this article (doi:10.1007/s12265-015-9642-4) contains supplementary material, which is available to authorized users. the time of LVAD implantation [8,9]. In order to perform minimally invasive intramyocardial implantation of stem cells in patients already supported by LVAD, a percutaneous approach has to be used.…”

Effects of Autologous Bone Marrow Mononuclear Cells Implantation in Canine Model of Pulmonary Hypertension

“…ABM-MNCs have been the most commonly used cell preparation in clinical studies. [30][31][32] MCT, a pyrrolizine alkaloid extracted from the seeds of Crotalaria spectabilis, 33 is converted by the mixed-function oxidase system of the liver into DMCT. The MCT-induced PH model is known to present similar pathology to that of primary PH.…”

Heart Transplantation: New Realities, Challenges and Developments - Surgical Perspectives

“…Furthermore, LVAD combined with angiotensin-converting enzyme inhibition results in decreased tissue angiotensin II and collagen cross-linking, normalizes left ventricular end-diastolic pressure volume relationships and is associated with modestly higher rates of bridge to recovery [27]. Other adjunctive treatments including other medications, cell or gene therapy with over expression of SERCA2a might in conjunction with VAD support provide a meaningful alternative therapy in patients with severe heart disease [28] (Figure 3). …”