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Iwanski J, Wong RK, Larson DF, Ferng AS, Runyan RB, Goldstein S, Khalpey Z. Remodeling an infarcted heart: novel hybrid treatment with transmyocardial revascularization and stem cell therapy. SPRINGERPLUS 2016; 5:738. [PMID: 27376006 PMCID: PMC4909685 DOI: 10.1186/s40064-016-2355-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/17/2016] [Indexed: 01/04/2023]
Abstract
Transmyocardial revascularization (TMR) has emerged as an additional therapeutic option for patients suffering from diffuse coronary artery disease (CAD), providing immediate angina relief. Recent studies indicate that the volume of surgical cases being performed with TMR have been steadily rising, utilizing TMR as an adjunctive therapy. Therefore the purpose of this review is to provide an up-to-date appreciation of the current state of TMR and its future developmental directions on CAD treatment. The current potential of this therapy focuses on the implementation of stem cells, in order to create a synergistic angiogenic effect while increasing myocardial repair and regeneration. Although TMR procedures provide increased vascularization within the myocardium, patients suffering from ischemic cardiomyopathy may not benefit from angiogenesis alone. Therefore, the goal of introducing stem cells is to restore the functional state of a failing heart by providing these cells with a favorable microenvironment that will enhance stem cell engraftment.
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Affiliation(s)
- Jessika Iwanski
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA ; Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Raymond K Wong
- Department of Pharmacology, University of Arizona College of Medicine, Tucson, AZ USA
| | - Douglas F Larson
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA
| | - Alice S Ferng
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA
| | - Raymond B Runyan
- Department of Cellular and Molecular Medicine, University of Arizona College of Medicine, Tucson, AZ USA
| | | | - Zain Khalpey
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, P.O. Box 245071, 1501N. Campbell Avenue, Tucson, AZ 85724-5071 USA ; Department of Physiological Sciences, University of Arizona College of Medicine, Tucson, AZ USA ; Banner University Medical Center, 1501N. Campbell Avenue, Room 4302A, Tucson, AZ 85724 USA ; Medical Research Building, 1656 E. Mabel St, Rm 120, Tucson, AZ USA
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Fast Track Minimally Invasive Transmyocardial Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:217-20. [DOI: 10.1097/imi.0b013e3181a69c51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective We evaluated the initial results of a fast-track discharge protocol for patients undergoing minimally invasive transmyocardial revascularization (MiTMR). Methods Fifteen male patients, aged 64.5 ± 9.2 years, with an ejection fraction of 46.8% ± 9.9%, underwent MiTMR through a mini-left anterior thoracotomy aided by robotic-controlled thoracoscopic assistance. A postoperative management protocol included immediate extubation, early chest tube and pulmonary artery catheter removal, and mobilization within 12 hours. Results There were no operative arrhythmias or in-hospital mortalities. Three of 15 patients developed left lower lobe atelectasis, delaying discharge between 2 and 5 days. Overall hospital length of stay was 1.4 ± 1.2 days, although 12 of 15 patients (80%) were discharged to home in 23 hours. Mild-moderate cardiomyopathy (ejection fraction 30%–50%) was not associated with prolonged length of stay. Mean hospital profit margin was $1882.50. One 30-day readmission occurred on day 23 for rapid atrial fibrillation, and one death occurred on day 11. Conclusions Despite these high-risk patients having end-staged, ischemic coronary artery disease, most MiTMR patients can be discharged to home in less than 24 hours. Perioperative morbidity and mortality rates are relatively low, and hospital profit margins are modest.
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