S. Miyagawa

Clinical impact of combined transplantation of autologous skeletal myoblasts and bone marrow mononuclear cells in patients with severely deteriorated ischemic cardiomyopathy

PurposeSimultaneous injection of autologous bone marrow cells and skeletal myoblasts has been demonstrated to improve cardiac function in animal models. We evaluated the potential application of this combination cell therapy in patients with severe ischemic cardiomyopathy who required left ventricular assist device (LVAD) implantation.MethodsFour patients (age range, 43–69 years) who required LVAD implantation due to severe ischemic cardiomyopathy were studied. Skeletal myoblasts were obtained from the thigh, while bone marrow mononuclear cells were collected and purified at the time of the operation. These cells were directly injected in a serial manner into the damaged myocardium.ResultsNo fatal arrhythmias or major complications were observed. The number of injected skeletal myoblasts ranged from 2.7 × 107 to 3.0 × 108, and their purity ranged from 25% to 96%. Two patients showed decreased brain natriuretic peptide levels and echocardiographic improvements in the transplanted areas, as well as increased perfusion revealed by H215O positron emission tomography, of whom one was successfully weaned from LVAD. Histological findings at autopsy of the other patient showed a small amount of skeletal muscle in the injected area. Only marginal improvements were observed in the other two patients.ConclusionsCombined cell transplantation is feasible for patients with severe ischemic cardiomyopathy, and functional recovery is anticipated in selected patients.

Jarvik 2000 biventricular assist device conversion from old pin-shaped bearing pumps to new conical bearing pumps

A patient with a Jarvik 2000 (Jarvik Heart, Inc., New York, NY) biventricular assist device had massive hemolysis and device insufficiency of the right ventricular assist device (RVAD) after the anticoagulation was temporarily reversed due to cerebral hemorrhage. After the patient’s condition was stabilized by bridge use of CentriMag (Levitronix LLC, Waltham, MA) for right ventricle support, the Jarvik 2000 pumps with pin-shaped bearings were exchanged with new conical bearing pumps. Examination of the removed pumps revealed tight thrombus formation around the pin-shaped bearings.

Hemodynamic Response to Continuous-flow Left Ventricular Assist Device Ramp Test and Volume Loading Predicts Successful Weaning from the Device Support

Introduction: Myocardial recovery occurs in small cohort of patients receiving left ventricular assist device (LVAD) support, but identification of candidates for device removal remains challenging. Hypothesis: We hypothesized that hemodynamic evaluation during LVAD speed ramp and volume loading test can assess cardiac recovery to predict successful device removal. Methods: The LVAD pump speed was decreased in 4 stages from the patient’s optimal speed to the minimal setting of the device. Under the minimal LVAD support, saline loading (body weight x 10mL in 15 minutes) was done. Echocardiographic and right heart catheter data were obtained in each stage of the LVAD ramp test, and every 3 minutes during the saline loading test. A total of 31 patients (HeartMate II 12, DuraHeart 7, Jarvik2000 5, EVAHEART 5, HVAD 2) underwent the test at our institution. The patients were divided into 2 groups: those who underwent successful LVAD explantation (Group R, n = 6) and those who did not (Group N, n = 25). Echocard...