Progenitor Cells From the Explanted Heart Generate Immunocompatible Myocardium Within the Transplanted Donor Heart

Rationale: Chronic rejection, accelerated coronary atherosclerosis, myocardial infarction, and ischemic heart failure determine the unfavorable evolution of the transplanted heart in humans. Objective: Here we tested whether the pathological manifestations of the transplanted heart can be corrected partly by a strategy that implements the use of cardiac progenitor cells from the recipient to repopulate the donor heart with immunocompatible cardiomyocytes and coronary vessels. Methods and Results: A large number of cardiomyocytes and coronary vessels were created in a rather short period of time from the delivery, engraftment, and differentiation of cardiac progenitor cells from the recipient. A proportion of newly formed cardiomyocytes acquired adult characteristics and was integrated structurally and functionally within the transplant. Similarly, the regenerated arteries, arterioles, and capillaries were operative and contributed to the oxygenation of the chimeric myocardium. Attenuation in the extent of acute damage by repopulating cardiomyocytes and vessels decreased significantly the magnitude of myocardial scarring preserving partly the integrity of the donor heart. Conclusions: Our data suggest that tissue regeneration by differentiation of recipient cardiac progenitor cells restored a significant portion of the rejected donor myocardium. Ultimately, immunosuppressive therapy may be only partially required improving quality of life and lifespan of patients with cardiac transplantation. (Circ Res. 2009; 105: 1128-1140.

Progenitor cells from the explanted heart generate immunocompatible myocardium within the transplanted donor heart

Rationale: Chronic rejection, accelerated coronary atherosclerosis, myocardial infarction, and ischemic heart failure determine the unfavorable evolution of the transplanted heart in humans. Objective: Here we tested whether the pathological manifestations of the transplanted heart can be corrected partly by a strategy that implements the use of cardiac progenitor cells from the recipient to repopulate the donor heart with immunocompatible cardiomyocytes and coronary vessels. Methods and Results: A large number of cardiomyocytes and coronary vessels were created in a rather short period of time from the delivery, engraftment, and differentiation of cardiac progenitor cells from the recipient. A proportion of newly formed cardiomyocytes acquired adult characteristics and was integrated structurally and functionally within the transplant. Similarly, the regenerated arteries, arterioles, and capillaries were operative and contributed to the oxygenation of the chimeric myocardium. Attenuation in the extent of acute damage by repopulating cardiomyocytes and vessels decreased significantly the magnitude of myocardial scarring preserving partly the integrity of the donor heart. Conclusions: Our data suggest that tissue regeneration by differentiation of recipient cardiac progenitor cells restored a significant portion of the rejected donor myocardium. Ultimately, immunosuppressive therapy may be only partially required improving quality of life and lifespan of patients with cardiac transplantation

Progenitor cells from the Explanted Heart generate immunocompatible myocardium within the Transplanted Donor Heart

Rationale: Chronic rejection, accelerated coronary atherosclerosis, myocardial infarction, and ischemic heart failure determine the unfavorable evolution of the transplanted heart in humans. Objective: Here we tested whether the pathological manifestations of the transplanted heart can be corrected partly by a strategy that implements the use of cardiac progenitor cells from the recipient to repopulate the donor heart with immunocompatible cardiomyocytes and coronary vessels. Methods and Results: A large number of cardiomyocytes and coronary vessels were created in a rather short period of time from the delivery, engraftment, and differentiation of cardiac progenitor cells from the recipient. A proportion of newly formed cardiomyocytes acquired adult characteristics and was integrated structurally and functionally within the transplant. Similarly, the regenerated arteries, arterioles, and capillaries were operative and contributed to the oxygenation of the chimeric myocardium. Attenuation in the extent of acute damage by repopulating cardiomyocytes and vessels decreased significantly the magnitude of myocardial scarring preserving partly the integrity of the donor heart. Conclusions: Our data suggest that tissue regeneration by differentiation of recipient cardiac progenitor cells restored a significant portion of the rejected donor myocardium. Ultimately, immunosuppressive therapy may be only partially required improving quality of life and lifespan of patients with cardiac transplantation. (Circ Res. 2009; 105: 1128-1140.

2018 ESC/EACTS Guidelines on myocardial revascularization.

Introducción: la cirugía de revascularización miocárdica avanza cada día más en cuanto a su efectividad terapéutica, pero todavía se hace necesario el control de determinados factores que pueden llevar a un pronóstico negativo. Objetivo: determinar los factores asociados a la incidencia de lesión miocárdica isquémica perioperatoria en los pacientes sometidos a cirugía de revascularización miocárdica. Material y Métodos: estudio analítico de casos y controles en pacientes con enfermedad multivasos sometidos a cirugía de revascularización miocárdica. El universo de 107 pacientes quedó dividido en: el grupo expuesto la lesión miocárdica isquémica perioperatoria (n=14) y el grupo no expuesto a esta (n=93). Se estudiaron variables epidemiológicas, clínicas, de laboratorio, electrocardiográficas y ecocardiográficas. Se usó el test chi cuadrado, el test exacto de Fisher y t de Student para comparación de medias, entre otros. Resultados: El área bajo la curva ROC determinó que el índice de masa corporal, el euroscore estándar, el tiempo quirúrgico, los valores de Creatinina y el índice leucoglicémico se asociaron predictivamente con la ocurrencia de lesión miocárdica isquémica perioperatoria. El análisis multivariado determinó como factores asociados al índice de masa corporal ≥ 24,9 kg/m2 (p=0,000), la clasificación de la New York Heart Association ≥ III (p=0,001), el euroscore estándar ≥ 4 puntos (p=0,037), el tiempo quirúrgico ≥ 4,7 h (p=0,015) y niveles de creatinina ≥ 101,5 μmol/L (p=0,050). Conclusiones: la identificación temprana de variables como el índice de masa corporal, la clasificación de la NYHA, el euroscore estándar, el tiempo quirúrgico y los niveles de Creatinina podría indicar qué pacientes necesitan un seguimiento más estrecho durante el preoperatorio

2018 ESC/EACTS Guidelines on myocardial revascularization

The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI)