Transmyocardial laser revascularization plus cell therapy for refractory angina

We report that the use of transmyocardial laser revascularization combined with intramyocardial injection is a therapeutic option for patients with severe ischemic heart disease (IHD) not amenable to conventional myocardial revascularization. Recently, cell therapy with autologous bone marrow cells (BMC) has been tested in clinical trials for severe IHD. We tested the hypothesis that TMLR combined with intramyocardial injection of BMC is safe, and may help increase the functional capacity and myocardial perfusion in patients with refractory angina. We enrolled 8 patients (7 men), 64 ± 4 years old, with refractory angina, non-candidates for another procedure. TMLR (8 ± 2 laser drills) was performed via a limited thoracotomy. BMC were obtained prior to surgery, and the lymphomonocytic fraction was separated by density gradient centrifugation. During surgery, 5 mL containing approximately 1.6 ± 0.2 × 108 BMC (CD34+ = 1.7 ± 0.4%) was delivered by multiple injections in the ischemic myocardium. We observed a reduction in the ischemic score as assessed by MRI from 1.56 ± 0.09 (B) to 0.93 ± 0.10 (6M) (P = 0.01), as well as a reduction in functional class of angina from 3.6 ± 0.2 (B) to 1.4 ± 0.2 (6M) (P < 0.0001). We concluded that, in this early experience, the combined strategy of TMLR plus cell therapy appeared to be safe, and may have synergistically acted to reduce myocardial ischemia, with clinically relevant improvement in functional capacity.