Background: Heart failure is highly prevalent among patients >65 years old. The incidence increases starting at approximately 45 years of age. Recent therapeutic advances have included stem cell transplantation in the affected areas of the myocardium in order to improve perfusion and myocardial performance.
Methods: Between July 13, 2004 and August 31, 2005, 39 procedures were undertaken in 34 male and 5 female patients, with a mean age of 53.6 +/- 9.08 years (range: 35-71 years old), suffering from terminal heart failure and without any other therapeutic alternative. Thirty four cases presented ischemic cardiomyopathy and five presented idiopathic dilated cardiomyopathy. All patients were treated with autologous stem cell transplantation obtained from the peripheral blood supply through hemophoresis and implanted by means of a left anterior thoracotomy via intramyocardial injection. Functional class, ejection fraction and myocardial perfusion were analyzed preoperatively and postoperatively.
Results: Seven patients presented ventricular fibrillation during the procedure, requiring defibrillation. Two patients died due to intractable arrhythmias during the perioperative period; the remaining patients are currently participating in a rehabilitation program with a favorable evolution. A mid-term follow-up has been completed in 27 patients. Preoperatively, the functional class for 26 of these patients was III. Postoperatively, functional classes are II in 5 cases and I in 15 patients at the mid-term evaluation with ejection fraction improvements of 37.7 +/- 14.2 to 42.15 +/- 5.9.
Conclusions: Cell therapy is a safe and useful procedure in selected patients with ischemic and idiopathic dilated cardiomyopathy.