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J Thorac Cardiovasc Surg 2000;119:62-068
© 2000 Mosby, Inc.
SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE |
From the Divisions of Cardiovascular Surgery and Cardiology, Department of Clinical Biochemistry, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Address for reprints: Ren-Ke Li, MD, PhD, Toronto General Hospital, University Health Network, CCRW 1-815, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4 (E-mail: RenKe.Li{at}uhn.on.ca).
Objective: Fetal cardiomyocyte transplantation improved heart function after cardiac injury. However, cellular allografts were rejected despite cyclosporine (INN: ciclosporin) therapy. We therefore evaluated autologous heart cell transplantation in an adult swine model of a myocardial infarction.
Methods: In 16 adult swine a myocardial infarction was created by occlusion of the distal left anterior descending coronary artery by an intraluminal coil. Four weeks after infarction, technetium 99m–sestamibi single photon emission tomography showed minimal perfusion and viability in the infarcted region. Porcine heart cells were isolated and cultured from the interventricular septum at the time of infarction and grown in vitro for 4 weeks. Through a left thoracotomy, either cells (N = 8) or culture medium (N = 8) was injected into the infarct zone.
Results: Four weeks after cell transplantation, technetium 99m–sestamibi single photon emission tomography demonstrated greater wall motion scores in the pigs receiving transplantation than in control animals (P = .01). Pigs receiving transplantation were more likely to have an improvement in perfusion scores (P = .03). Preload recruitable stroke work (P = .009) and end-systolic elastance (P = .02) were greater in the pigs receiving transplantation than in control animals. Scar areas were not different, but scar thickness was greater (P = .02) in pigs receiving transplantation. Cells labeled with bromodeoxyuridine in vitro could be identified in the infarct zone 4 weeks after transplantation. Swine receiving transplantation gained more weight than control animals (P = .02).
Conclusion: Autologous porcine heart cell transplantation improved regional perfusion and global ventricular function after a myocardial infarction.
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