Abstract
Introduction. Currently, alternative methods for the treatment of coronary artery disease (transmyocardial laser
revascularization (TMLR) and autologous bone marrow stem cells (ABMSC) injection) are being actively introduced
around the world in situations where it is not possible to perform direct myocardial revascularization. Relying
on the synergism of TMLR and intramyocardial injection of ABMSC, it was proposed to combine both methods.
Aim of the study – to evaluate the long-term results of TMLR using a CO2-laser in combination with intramyocardial
injection of ABMSC as an isolated procedure in patients with the end-stage coronary artery disease.
Material and methods. The study included 20 patients (90% male), with a mean age of 58.4±8.7 years. To assess the
long-term results, patients were examined in a hospital. The Minnesota Living with Heart Failure Questionnaire and
the Seattle Angina Questionnaire were used. The evolution of laboratory and instrumental indices, as well as medical
therapy, were assessed. The end points of the study were death, acute myocardial infarction (AMI), repeated myocardial
revascularization, recurrent hospitalizations due to coronary artery disease, stroke. The changes in angina functional
class were also evaluated.
Results. The median of follow-up period was 54 (36; 83) months, that is 4.5 years. The analysis of the evolution of
echocardiographic data showed the absence of statistically significant changes in the following parameters: left ventricular
end-diastolic diameter (p=0.967), end-systolic diameter (p=0.204), end-diastolic volume (p=0.852), endsystolic
volume (p=0.125), left ventricular ejection fraction (p=0.120). The patients continued to regularly take the
main groups of medications. Nitrate consumption was significantly reduced (p<0.001).
Significant positive dynamics were observed in the changes in angina functional class (FC). At the baseline, all
patients had angina III FC, in the long term – 3 patients had II FC, 11 patients – I FC, and 6 patients had no angina.
Clinical outcomes (mortality, recurrent myocardial infarction, stroke) were absent during the follow-up period.
There were 2 cases of repeated myocardial revascularization.
Regression analysis revealed that SYNTAX score was associated with the clinical outcome “repeated revascularization”.
Conclusion. TMLR in combination with intramyocardial injection of ABMSC is a safe method to achieve a statistically
significant antianginal effect and reduce the need for nitrates, which in turn improves the quality of life and
reduces the frequency of hospitalizations due to coronary artery disease. These results can be achieved with strict
adherence to the certain indications for the intervention.
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About the authors
- Leo A. Bockeria, Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences, Director; orcid.org/0000-0002-6180-2619
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Ol'ga L. Bockeria, Corresponding Member of RAS, Chief Researcher; orcid.org/0000-0002-7711-8520
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Andrey D. Petrosyan, Cardiovascular Surgeon; orcid.org/0000-0002-0001-0693
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Vladimir A. Shvarts, Cand. Med. Sc., Researcher; orcid.org/0000-0002-8931-0376
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Sergey A. Donakanyan, Cand. Med. Sc., Cardiovascular Surgeon, Head of Department; orcid.org/0000-0003-0942-2931
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Mikhail B. Biniashvili, Cand. Med. Sc., Cardiovascular Surgeon; orcid.org/0000-0003-2988-309X
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Artak Yu. Ispiryan, Researcher
