LONG-TERM RESULTS OF TRANSMYOCARDIAL LASER REVASCULARIZATION COMBINED WITH IMPLANTATION OF AUTOLOGOUS BONE MARROW MONONUCLEAR FRACTION IN THE TREATMENT OF CHRONIC ISCHEMIC HEART DISEAS

Aim. Clinical and instrumental assessment of long-term results of autologous bone marrow cells (BMC) implantation in laser channels in surgery of ischemic heart disease with diffuse and distal coronary disease.

Materials and Methods. In the period of 2007–2008 35 CHD patients with diffuse and distal coronary disease underwent BMC implantation in laser channels during coronary artery bypass grafting (CABG). The control group consisted of 29 patients. All patients in this group underwent only direct myocardial revascularization (DMR). In the long-term period we examined only 30 patients of the first group. Clinical and instrumental assessment of the method efficacy was carried out in 2 weeks, 6 months and 6 years after surgery.

Results. FC (NYHA) mean value in indirect revascularization group significantly decreased from 2.57 ± 0.61 preoperatively to 1.77 ±0.66 in6 months after surgery (p = 0.043). After 6 years FC (NYHA) was not significantly changed – 1.84 ± 0.42 (p = 0.053). Perfusion scintigraphy revealed a slight decrease of stable perfusion defect (SPD) in the immediate postoperative period, a more pronounced reduction of SPD in 6 months after surgery. The average value of SPD before surgery was 20.46 ± 10.75%, in 2 weeks after the operation – 19.07 ± 9.69%, in 6 months after surgery – 15.22 ± 9.49%. In the long-term period (6 years) SPD was 14.8 ± 8.43% (p = 0.047). A similar pattern was observed in the analysis of transient perfusion defect: baseline – 30 ± 2.2%, in 6 months – 15 ± 1.3%, in the long term period – 20 ± 6.1% (p = 0.047). The average value of left ventricular ejection fraction (LVEF) before surgery was 55 ± 10.4%, in 2 weeks after the operation – 55.7 ± 9.3%, in 6 months – 56.7 ± 10%, after 6 years – 54 ± 12%. The dynamics is unauthentic (p = 0.068).

Conclusion. BMC implantation in laser channels in addition to CABG is a safe and effective method of surgical treatment in case of CABG inability. The effect of indirect revascularization is formed in the first 6 months after surgery and remains at the same level for 6 years. 

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