Клиническая практика (Oct 2020)
Options for using cellular cardiomyoplasty for coronary heart disease
Abstract
Background. Despite a significant arsenal of medications and methods of surgical correction of myocardial blood supply, treatment of some forms of coronary heart disease remains relevant. Aim of the work is to analyze the effectiveness of the use of mesenchymal stem cells (МSC) of bone marrow in autologous transendocardial transplantation in some forms of IHD. Methods. In the near and long-term results, we analyzed the histories and diseases and conducted a survey of 68 patients. Of the 68 patients, the largest group was men 53 (77.9%), women were much fewer 15 (22.1%). Then we formed 4 groups (17 patients each): 1 group control patients received standard drug therapy; Group 2 to patients who received standard therapy, empty myocardial injections were performed using a catheter and the NOGA XP navigation system; Group 3 auto-CCK was administered intravenously to patients; 4 group against the background of therapy, transendocardial auto-МSС was administered. Results. When analyzing the patients subjective sensations in group I, after 3 months in group 1, 4 patients (32%) noted improvement, unchanged 11 (64.7%), worsening 2 (11.8%) and significant worsening 1 (5.9%). In group 2, improvement was in 1 patient, which was 5.9%, unchanged 13 (76.5%), worsening 2 (11.8%) and significant deterioration 2 (11.8%). In group 3, improvement was observed in 5 patients 29.4%, significant improvement in 1 (5.9%), deterioration and significant deterioration in 1 patient (5.9% each, respectively). In group 4 unchanged 6 (35.3%) patients, improvement 7 (41.2%), significant improvement 4 (32%), worsening 1 (5.9%). Cell transplantation, regardless of the method of administration, increases the EF and reduces the EDV of the left ventricle, more significantly in the group with a transendocardial route of administration. Conclusion. In accordance with published data, we obtained similar data transplantation of human bone marrow SSC with autologous administration causes a positive effect in the form of increased EF LV, decreased EDV of the LV, increased exercise tolerance and a significant improvement in patients well-being. It should be noted that intravenous and intracoronary administration of auto-МSC is less effective in the studied parameters than transendocardial introduction of cells into the myocardium.
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