Transcatheter targeted myocardial restoration using hydrogel-based cell-free compound: Toward an adoptable clinical protocolCentral MessagePerspective
Faizus Sazzad, MBBS, MS, FRCS, FCPS, FACS, FACC,
Michał Kuzemczak, MD, PhD, MSc,
Zhengfeng Jason Chen, MBBS, MRCP,
Jonas Fine Tan,
Zhi Xian Ong, MBBS,
Arthur Mark Richards, MBChB, MD, PhD, FRCP,
Theo Kofidis, MD, PD(Ger), FRCS, FAHA, FAMS
Affiliations
Faizus Sazzad, MBBS, MS, FRCS, FCPS, FACS, FACC
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore
Michał Kuzemczak, MD, PhD, MSc
Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Division of Emergency Medicine, Poznan University of Medical Sciences, Poznań, Poland
Zhengfeng Jason Chen, MBBS, MRCP
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
Jonas Fine Tan
Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Zhi Xian Ong, MBBS
Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Arthur Mark Richards, MBChB, MD, PhD, FRCP
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore; Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
Theo Kofidis, MD, PD(Ger), FRCS, FAHA, FAMS
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University of Singapore, Singapore; Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore; Address for reprints: Theo Kofidis, MD, PD(Ger), FRCS, FAHA, FAMS, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Rd, Singapore, 119228.
Background: There is a need for a targeted, comprehensive, minimally invasive myocardial restoration treatment aimed at patients with chronic postinfarction heart failure that can provide a sustained effect and be conveniently adopted with transcatheter techniques. Here we evaluated the effectiveness of a platelet-rich plasma hydrogel-based, cell-free therapeutic compound delivered with the aid of a 3-dimensional electromechanical mapping and catheter-based technique (NOGA) in a porcine translational model. Methods: We assessed the feasibility of targeted, minimally invasive transcatheter NOGA-guided injections of the therapeutic compound in myocardial infarction (MI) survivors at 8 weeks post-MI. Results: Animals undergoing NOGA-guided hydrogel injections at 8 weeks post-MI demonstrated a significant improvement of the selected left ventricular parameters at a 12-week follow-up. Compared to nonintervention, the hydrogel-based therapy provided significant improvements in end-diastolic volume (−11.0% ± 11.1% vs 6.3% ± 15.2%; P = .008) and ejection fraction (−9.1% ± 16% vs 12.7% ± 18.6%; P = .009). In the slice closest to the apex, significant differences in scar area were observed; the treatment group demonstrated a smaller mean scar area in the infarcted zone compared with the control group (47.1% ± 7.0% vs 59% ± 8.2%; P = .013) and a smaller mean scar area in the border zone compared with the saline group (31.4% ± 8.3% vs 42.6% ± 9.0%; P = .016). Conclusions: The study implies a translational potential of the hydrogel-based therapy and should trigger clinical trials focused on establishing a restoration therapy that can be integrated into a clinical protocol.
