Estrin S. Cellular cardiomyoplasty in the complex treatment of refractory angina pectoris (experimental and clinical study)

Experimental studies have shown that cellular cardiomyoplasty (regardless of the method of administration of stem cells) improves the structure of postinfarction heart. The positive effect of injections into the myocardium and intramyocardial administration of auto-MSCs on the functional reserve and metabolism of cardiomyocytes due to the paracrine effect and stimulation of angiogenesis processes has been proven, which was confirmed by a significant increase in the VEGF level to (132,74±19,87) and (111,43±12,22) pg/ml, an increase in the concentration of nitric oxide derivatives to (0,96±0,05) and (0,92±0,03) μg/ml with a simultaneous decrease in the concentration of endothelin-1 to normal values. Mesenchymal stem cell transplantation increases LVEF from (55,3±3,4) % to (66,5±3,3) (t=2,5, p<0,05) and SV c (0,13±0,03) ml to (0,18±0,02) ml (t=1,9, p<0,05). Experimental studies have shown that the qualitative reaction of the heart to stress-mimicking loads after intravenous and endomyocardial administration of autologous mesenchymal bone marrow stem cells increased by +38 and 39, respectively, which is due to SC homing towards ischemia with their differentiation into vascular endothelial cells and the paracrine effect. Transplantation of autologous mesenchymal stem cells using a navigation system Noga XP is a safe and effective procedure, is not accompanied by postoperative complications, contributes to an increase in the survival time to 35 (18–61) months, a decrease in mortality at the stage of 36-month control from 46,7 to 13,3 %, in order to achieve the maximum effect of treatment after 1 year, it is advisable to carry out a repeated transplantation of autologous mesenchymal bone marrow stem cells.