Part III: Implant Technique

Heart disease is still one of the most common causes of death world wide. Despite advances in its treatment, like better pharmaceutical products and progress in interventional cardiology and surgical techniques.

The rapid aperture of an occluded artery, and the standard medical treatment after a myocardial infarction have improved the survival of patients, but have not reduced, it as desired. The main long term effects on ventricular dilation (remodeling), which is the main cuse of heart failure.

On the other hand, there are many patients with coronary artery disease (chest pain), refractory to conventional medical therapy, without a single chance of revascularization (angioplasty or surgery), who have their lives seriously limited.

A third group of patients are those with heart failure, due to either previous myocardial infarction or severe coronary artery disease. They are not only at risk of sudden death, but require also several admissions due to decompensation of the underlying cardiac disease.

These patient groups can benefits with stem cells therapy, always in addition to conventional medical treatment. This novel technique, uses stem cells from the bone marrow and implants them, either by a catheter or directly by surgery in the left ventricle.

The exact mechanism that makes those stem cells improve the cardiac function in the patients is not clear. However, it could be due to the stimuli on the generation on new vessels and the improvement of function of the cells close to affected area.

The effects of this novel therapy on patients’ quality of life are finally due to a better cardiac function and dimishing of chest pain episodes.

Next we are going to describe some techniques for stem cells implantation.

CATHETER TECHNIQUE

Catheter technique consists in the injection of stem cells from bone marrow through a catheter.
This procedure begins with the punction of iliac cresta bone, under sedation, to aspirate an adequate amount of bone marrow blood. Then, while patient takes a rest, the blood is processed. After a couple of hours the concentrated and purified selected stem cells are ready for injection. Finally, and under local anesthesia, stem cells are injected through a catheter on the heart arteries or veins. This procedure is done through a needle usually in the groin area, with local anesthesia. It is not painful and has very low risk or side effects. The next day patients can usually be discharged and resume normal life.

STEM CELLS INJECTION THROUGH A CATHETER

Stem cells injection

SURGICAL TECHNIQUE

This technique is used in patients that undergo coronary artery by pass graft surgery. Stem cells are injected directly in the infracted areas in the open heart procedure. It is stated that this could retard or avoid a cardiac transplant. At the moment of by pass surgery, the surgeon uses the aperture of the thorax for a direct injection of cells close to necrotic areas, getting a great engraftment of the cells.