Haemodynamics during maximal exercise after coronary bypass surgery

Fifty patients underwent an objective measurement of physical working capacity by means of a multistage test of maximally tolerated exertion before and after coronary bypass surgery; 29 patients also had haemodynamic measurements during maximal exercise before and after coronary bypass surgery. The patients were divided into 3 groups according to the degree of revascularisation: adequate (n = 20), partial (n = 17), or none (n = 13). Adequate revascularisation induces a large increase in physical working capacity because of an increased maximal heart rate and maximal cardiac output; stroke volume during maximal exercise and ejection fraction at rest were not modified, suggesting no major changes in left ventricular function. After unsuccessful coronary bypass surgery, the physical working capacity was unchanged despite an increased maximal heart rate; maximal cardiac output was unchanged and stroke volume during maximal exercise was significantly lower. These undesirable results are often associated with perioperative myocardial infarction and are attended by a decreased ejection fraction at rest; these data suggest an impaired left ventricular function after unsuccessful coronary bypass surgery. The results of partial revascularisation are intermediate but appear to be determined by the incidence of partial graft failure which is also often associated with perioperative myocardial infarction. From individual changes in data collected during maximal exercise testing, it is often impossible to predict the degree of revascularisation

Mesenchymal stem cells in solid organ transplantation (MiSOT) fourth meeting: Lessons learned from first clinical trials

The Fourth Expert Meeting of the Mesenchymal Stem Cells in Solid Organ Transplantation (MiSOT) Consortium took place in Barcelona on October 19 and 20, 2012. This meeting focused on the translation of preclinical data into early clinical settings. This position paper highlights the main topics explored on the safety and efficacy of mesenchymal stem cells as a therapeutic agent in solid organ transplantation and emphasizes the issues (proper timing, concomitant immunossupression, source and immunogenicity of mesenchymal stem cells, and oncogenicity) that have been addressed and will be followed up by the MiSOT Consortium in future studies