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European Heart Journal Advance Access originally published online on June 26, 2009
European Heart Journal 2009 30(19):2354-2359; doi:10.1093/eurheartj/ehp262
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Randomized controlled trial on the cardioprotective effect of bone marrow cells in patients undergoing coronary bypass graft surgery

Vien Khach Lai1,{dagger}, Keng-Leong Ang1,{dagger}, Wendy Rathbone1, Nicholas James Harvey2 and Manuel Galiñanes1,*

1 Cardiac Surgery Unit, Department of Cardiovascular Sciences, University of Leicester, Clinical Science Wing, Glenfield Hospital, Leicester LE3 9QP, UK
2 Glenfield Hospital, Leicester LE3 9QP, UK

Received 23 January 2009; revised 28 April 2009; accepted 25 May 2009; online publish-ahead-of-print 26 June 2009.

* Corresponding author. Tel: 44 116 256 3031, Fax: 44 116 250 2449, Email: mg50{at}le.ac.uk or mg50{at}leicester.ac.uk

Aims: This randomized study investigates whether bone marrow cells (BMCs) can reduce ischaemic injury during cardiac surgery.

Methods and results: Forty-four elective coronary artery bypass grafting patients were randomized to control group or BMCs group (whereby autologous BMCs were administered with each dose of cardioplegia antegradely into the coronaries). Troponin I and CK-MB were measured during the first 48 h after surgery and were not significantly different between the control and BMCs groups. The role of cardiopulmonary bypass (CPB) on the cardioprotective effects of BMCs was also studied using an in vitro model of stimulated ischaemia and reoxygenation on right atrial appendages obtained from controls either before or 10 min after the initiation of CPB. Bone marrow cells significantly reduced myocardial injury in muscles obtained prior to CPB. This effect was comparable with ischaemic preconditioning (IP), although their combination did not afford additional benefit. However, when muscles were harvested after CPB, myocardial injury in the ischaemic group alone was less, and BMCs or IP did not exert further protection.

Conclusion: Bone marrow cells did not afford additional benefit when used as an additive to cardioplegia during CPB. However, BMCs offer cardioprotection as potent as IP, when the heart is not subjected to stress, such as CPB, that per se can precondition the myocardium.

Key Words: Bone marrow cells • Cardioprotection • Coronary artery bypass grafting • Cardioplegia • Ischaemic preconditioning

{dagger} The first two authors contributed equally to the study.


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