CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Percutaneous transvenous cellular cardiomyoplasty
A novel nonsurgical approach for myocardial cell transplantation
Craig A. Thompson, MD* ||,*,
Boris A. Nasseri, MD ,
Joshua Makower, MD¶,
Stuart Houser, MD ,
Michael McGarry, MSc,
Theodore Lamson, PhD,
Irina Pomerantseva, MD, PhD*,
John Y. Chang, MS ME¶,
Herman K. Gold, MD, FACC*,
Joseph P. Vacanti, MD and
Stephen N. Oesterle, MD, FACC*
* Cardiovascular Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Tissue Engineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Pathology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
|| Massachusetts Institute of Technology, Division of Health Sciences and Technology, Cambridge, Massachusetts, USA
¶ TransVascular, Inc., Menlo Park, California, USA
Manuscript received August 15, 2002;
revised manuscript received November 2, 2002,
accepted December 18, 2002.
* Reprint requests and correspondence: Dr. Craig A. Thompson, Knight Center for Cardiac Catheterization and Intervention, Massachusetts General Hospital, 55 Fruit Street, Blake 950, Boston, Massachusetts 02114, USA.
cathompson{at}partners.org
OBJECTIVES: The study evaluated a nonsurgical means of intramyocardial cell introduction using the coronary venous system for direct myocardial access and cell delivery.
BACKGROUND: Direct myocardial cell repopulation has been proposed as a potential method to treat heart failure.
METHODS: We harvested bone marrow from Yorkshire swine (n = 6; 50 to 60 kg), selected culture-flask adherent cells, labeled them with the gene for green fluorescence protein, expanded them in culture, and resuspended them in a collagen hydrogel. Working through the coronary sinus, a specialized catheter system was easily delivered to the anterior interventricular coronary vein. The composite catheter system (TransAccess) incorporates a phased-array ultrasound tip for guidance and a sheathed, extendable nitinol needle for transvascular myocardial access. A microinfusion (IntraLume) catheter was advanced through the needle, deep into remote myocardium, and the autologous cell–hydrogel suspension was injected into normal heart. Animals were sacrificed at days 0 (n = 2), 14 (n = 1, + 1 control/collagen biogel only), and 28 (n = 2), and the hearts were excised and examined.
RESULTS: We gained widespread intramyocardial access to the anterior, lateral, septal, apical, and inferior walls from the anterior interventicular coronary vein. No death, cardiac tamponade, ventricular arrhythmia, or other procedural complications occurred. Gross inspection demonstrated no evidence of myocardial perforation, and biogel/black tissue dye was well localized to sites corresponding to fluoroscopic landmarks for delivery. Histologic analysis demonstrated needle and microcatheter tracts and accurate cell–biogel delivery.
CONCLUSIONS: Percutaneous intramyocardial access is safe and feasible by a transvenous approach through the coronary venous system. The swine offers an opportunity to refine approaches used for cellular cardiomyoplasty.
|
Abbreviations and Acronyms
| | AIV | | anterior interventricular coronary vein | | CHF | | congestive heart failure | | CS | | coronary sinus | | GCV | | great cardiac vein | | GFP | | green fluorescence protein | | IVUS | | intravascular ultrasound | | MI | | myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
B. J. Gersh, R. D. Simari, A. Behfar, C. M. Terzic, and A. Terzic
Cardiac Cell Repair Therapy: A Clinical Perspective
Mayo Clin. Proc.,
October 1, 2009;
84(10):
876 - 892.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Hung, J. Solis, J. L. Guerrero, G. J.C. Braithwaite, O. K. Muratoglu, M. Chaput, L. Fernandez-Friera, M. D. Handschumacher, V. J. Wedeen, S. Houser, et al.
A Novel Approach for Reducing Ischemic Mitral Regurgitation by Injection of a Polymer to Reverse Remodel and Reposition Displaced Papillary Muscles
Circulation,
September 30, 2008;
118(14_suppl_1):
S263 - S269.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fukushima, A. Varela-Carver, S. R. Coppen, K. Yamahara, L. E. Felkin, J. Lee, P. J.R. Barton, C. M.N. Terracciano, M. H. Yacoub, and K. Suzuki
Direct Intramyocardial But Not Intracoronary Injection of Bone Marrow Cells Induces Ventricular Arrhythmias in a Rat Chronic Ischemic Heart Failure Model
Circulation,
May 1, 2007;
115(17):
2254 - 2261.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Widimsky, M. Penicka, O. Lang, T. Kozak, Z. Motovska, R. Jirmar, and M. Aschermann
Intracoronary transplantation of bone marrow stem cells: background, techniques, and limitations
Eur. Heart J. Suppl.,
December 1, 2006;
8(suppl_H):
H16 - H22.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. L. Christman and R. J. Lee
Biomaterials for the Treatment of Myocardial Infarction
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
907 - 913.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. J. Boyle, S. P. Schulman, and J. M. Hare
Stem Cell Therapy for Cardiac Repair: Ready for the Next Step
Circulation,
July 25, 2006;
114(4):
339 - 352.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Oettgen
Cardiac Stem Cell Therapy: Need for Optimization of Efficacy and Safety Monitoring
Circulation,
July 25, 2006;
114(4):
353 - 358.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Dimarakis, N. A. Habib, and M. Y.A. Gordon
Adult bone marrow-derived stem cells and the injured heart: just the beginning?
Eur. J. Cardiothorac. Surg.,
November 1, 2005;
28(5):
665 - 676.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Brasselet, M. C. Morichetti, E. Messas, C. Carrion, A. Bissery, P. Bruneval, J.-T. Vilquin, A. Lafont, A. A. Hagege, P. Menasche, et al.
Skeletal myoblast transplantation through a catheter-based coronary sinus approach: an effective means of improving function of infarcted myocardium
Eur. Heart J.,
August 1, 2005;
26(15):
1551 - 1556.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Singh, S. Houser, E. K. Heist, and J. N. Ruskin
The Coronary Venous Anatomy: A Segmental Approach to Aid Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol.,
July 5, 2005;
46(1):
68 - 74.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Siminiak, D. Fiszer, O. Jerzykowska, B. Grygielska, N. Rozwadowska, P. Kalmucki, and M. Kurpisz
Percutaneous trans-coronary-venous transplantation of autologous skeletal myoblasts in the treatment of post-infarction myocardial contractility impairment: the POZNAN trial
Eur. Heart J.,
June 2, 2005;
26(12):
1188 - 1195.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fazel, G. H.L. Tang, D. Angoulvant, M. Cimini, R. D. Weisel, R.-K. Li, and T. M. Yau
Current Status of Cellular Therapy for Ischemic Heart Disease
Ann. Thorac. Surg.,
June 1, 2005;
79(6):
S2238 - S2247.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Sousa, M. A. Costa, E. M. Tuzcu, J. S. Yadav, and S. Ellis
New Frontiers in Interventional Cardiology
Circulation,
February 8, 2005;
111(5):
671 - 681.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. C. Wollert and H. Drexler
Clinical Applications of Stem Cells for the Heart
Circ. Res.,
February 4, 2005;
96(2):
151 - 163.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Raake, G. von Degenfeld, R. Hinkel, R. Vachenauer, T. Sandner, S. Beller, M. Andrees, C. Kupatt, G. Schuler, and P. Boekstegers
Myocardial gene transfer by selective pressure-regulated retroinfusion of coronary veins: Comparison with surgical and percutaneous intramyocardial gene delivery
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
1124 - 1129.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Chachques, C. Acar, J. Herreros, J. C. Trainini, F. Prosper, N. D'Attellis, J.-N. Fabiani, and A. F. Carpentier
Cellular cardiomyoplasty: clinical application
Ann. Thorac. Surg.,
March 1, 2004;
77(3):
1121 - 1130.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
