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Randomized Controlled Trial
. 2020 Apr;35(4):740-746.
doi: 10.1111/jocs.14454. Epub 2020 Feb 12.

Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction

Tri Wisesa Soetisna  1   2 , Renan Sukmawan  3   4 , Budhi Setianto  3   4 , Muchtaruddin Mansyur  5 , Tri Wahyu Murni  6 , Erlin Listiyaningsih  7 , Anwar Santoso  3   4
Affiliations
Randomized Controlled Trial

Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction

Tri Wisesa Soetisna et al. J Card Surg. 2020 Apr.

Abstract

Objectives: Autologous CD133+ bone marrow stem cells may improve cardiac function. This randomized, single-blind clinical trial inquired whether a combined transepicardial and transseptal implantation of CD133+ stem cells during coronary artery bypass grafting (CABG) improve cardiac function with ejection fraction (EF) changes as a primary endpoint in patients with low EF.

Methods: Thirty patients with coronary heart disease and EF <35% were randomized to undergo CABG alone or CABG with transseptal and transepicardial implantation of CD133+. Cardiac function was evaluated using cardiac magnetic resonance imaging (MRI) before and 6 months after CABG.

Results: Preoperative EF was lower in the intervention group (25.88% ± 5.66%) than in the control group (30.18% ± 3.85%; P = .04). The adverse event incidence was similar between both groups. At 6 months, EF changes were significantly higher (8.69% ± 9.49; P = .04) in the CD133+ group than in the CABG-only group. Compared to the control group, significant improvements were seen in the wall motion score index (P = .003) and scar size proportion (P = .047) in the CD133+ group. The quality of life (QOL), assessed by a 6-minute walking test, showed considerable improvement in the CD133+ group compared to that in the control group (P = .03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale did not show improvement in the intervention group (P = .09, vs control).

Conclusion: Combined transepicardial and transseptal autologous CD133+ BMC implantation during bypass grafting improved cardiac function in low EF coronary artery disease patients.

Keywords: coronary artery bypass graft; coronary artery disease; heart failure; stem cell.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Echocardiography visualization of the transseptal injection
Figure 2
Figure 2
Boxplot diagram of left ventricular ejection fraction (LVEF) of patients treated with CABG plus CD133+ and CABG only. Comparison of changes (Δ) of LVEF. The improvement of LVEF in the CD133+ group after the intervention was significantly higher than CABG only group (P = .04). Data were presented as median and minimum‐maximum. CABG, coronary artery bypass grafting
Figure 3
Figure 3
Comparison of wall motion score index (WMSI) changes between both groups. The decrement of the WMSI score (Δ) in the CD133+ group was significantly lower than the changes in the CABG group (P = .01). Box plot was presented in the median and minimum maximum. Δ score was presented in mean ± SD. CABG, coronary artery bypass grafting
Figure 4
Figure 4
Comparison of scar size proportion improvement between both groups. There was a reduction in scar size proportion in the CD133+ group, on the contrary, there was an increment of scar size proportion in the CABG group (P = .04). Box plot is presented in median and minimum‐maximum. Δ score was presented in mean ± SD. CABG, coronary artery bypass grafting
See this image and copyright information in PMC

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