Intramyocardial Navigation and Mapping for Stem Cell Delivery

Abstract

Method for delivery remains a central component of stem cell-based cardiovascular research. Comparative studies have demonstrated the advantages of administering cell therapy directly into the myocardium, as distinct from infusing cells into the systemic or coronary vasculature. Intramyocardial delivery can be achieved either transepicardially or transendocardially. The latter involves percutaneous, femoral arterial access and the retrograde passage of specially designed injection catheters into the left ventricle, making it less invasive and more relevant to wider clinical practice. Imaging-based navigation plays an important role in guiding catheter manipulation and directing endomyocardial injections. The most established strategy for three-dimensional, intracardiac navigation is currently endoventricular, electromechanical mapping, which offers superior spatial orientation compared to simple x-ray fluoroscopy. Its provision of point-by-point, electrophysiologic and motion data also allows characterization of regional myocardial viability, perfusion, and function, especially in the setting of ischemic heart disease. Integrating the mapping catheter with an injection port enables this diagnostic information to facilitate the targeting of intramyocardial stem cell delivery. This review discusses the diagnostic accuracy and expanding therapeutic application of electromechanical navigation in cell-based research and describes exciting developments which will improve the technology's sensing capabilities, image registration, and delivery precision in the near future.

Emerging roles for integrated imaging modalities in cardiovascular cell-based therapeutics: a clinical perspective

“…Cell retention and myocardial distribution are similar between the transendocardial and transepicardial strategies [26], although catheter-based injection is less invasive, increasing its broader clinical applicability and potentially making it amenable to repeated cell interventions [27]. It is in this context of transendocardial delivery, more so than for other delivery routes, that an important role has emerged for adjuvant imaging to guide the location of injection sites and determine the success of cell implantation in the myocardium [28]. …”

Autologous Concentrate Bone Marrow Cell Therapy for Ischemic Cardiomyopathy Unsuitable for Revascularization: Feasibility Study

“…Injection of intracoronary stem cells has inherent limitation related to homing and the possibility of micro infarctions [32]. The endomyocardial route does not allow accurate delivery [33].…”

Cellular Therapy for Heart Failure

“…This typically entails femoral artery access, with retrograde passage of the delivery catheter across the aortic valve into the LV cavity. There are various commercially available injection catheters, reviewed previously [179]. Catheter manipulation and selection of injection sites are most commonly navigated by fluoroscopic guidance or electromechanical mapping.…”