Intracoronary administration of autologous bone marrow mononuclear cells in patients with chronic ischemic symptomatic cardiomyopathy: 5 years follow-up

Background: Several studies have demonstrated the shortterm safety, feasibility and efficacy of cell transplantation in patients with advanced heart failure. Data on the long-term outcome are lacking. Objectives: To evaluate the long-term outcome of intracoronary autologous bone marrow administration in patients with stable severe ischemic cardiomyopathy who were not suitable for revascularization. Methods: We enrolled eight consecutive patients with ischemic cardiomyopathy: all were in NYHA functional class III-IV despite optimal medical treatment. Dobutamine stress echo showed that all had left ventricular ejection fraction < 35% with significant viability or ischemia, or both, in at least two myocardial segments. Based on coronary anatomy none of the patients was suitable for revascularization. Bone marrow was obtained and the cells were injected into all patent conduits after a brief balloon occlusion at a normal coronary segment. Clinical followup was performed periodically at the heart failure clinic, and included electrocardiography, laboratory tests and echocardiography. Results: During 5 years follow-up there were two deaths: one due to leukocytoclastic vasculitis 21 months after intracoronary bone marrow infusion, and the second patient died suddenly during sleep 30 months after the transplant. The other six patients are alive, two of them without any cardiovascular or clinical events. No significant change in systolic and diastolic function was observed on echocardiography. Conclusions: Despite the small and selected patient group, our long-term follow-up showed a promising outcome for this population of patients suffering from severe cardiac disease. Longer follow-up of a much larger group is needed.