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Effective combined off-pump surgical treatment and autologous bone marrow cell transplantation: a new alternative for patients with end-stage ischemic cardiomyopathy (Prapas’ procedure) [Anatol J Cardiol]
Anatol J Cardiol. 2008; 8(Suppl. 2): 101-107

Effective combined off-pump surgical treatment and autologous bone marrow cell transplantation: a new alternative for patients with end-stage ischemic cardiomyopathy (Prapas’ procedure)

Sotirios Prapas1, Dimitrios Protogeros1, Fotini Danou2, Chrysanthi Trikka3, Ioannis Panagiotopoulos1, Helen Chandrinou4
1From Departments of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece
2From Departments of Anesthesia, Henry Dunant Hospital, Athens, Greece
3From Departments of Cardiology, Henry Dunant Hospital, Athens, Greece
4From Departments of Immunohematology and Transfusion Medicine, Henry Dunant Hospital, Athens, Greece

Objective: To propose an alternative method combined off-pump treatment of end-stage ischemic cardiomyopathy consisting of
revascularization of ischemic areas, external reshaping of the left ventricle (LV) in order to restore near normal geometry and autologous bone marrow-derived mononuclear cell (BM-MNC) implantation.
Methods: Forty- seven patients (mean age 58±8.9 years) underwent the above procedure. All patients were NYHA III-IV and four were
transplantation candidates. They underwent standard laboratory evaluation, transthoracic echocardiography, dipyridamole thallium
scintigraphy (DTS) and cardiac magnetic resonance imaging preoperatively and at 3rd, 6th and 12th months postoperatively. After
revascularization and external LV reshaping, BM-MNCs were injected into predetermined peri-infarct areas.
Results: Forty-five patients survived during a follow up period of 3-37 months. Ejection fraction improved from 21.7±7.4% to 30.6±6.9%, 36.5±4.3% and 37.7±4.2% at 3rd, 6th and 12th months, respectively. Left ventricular end-diastolic diameter was reduced from 66.1±4.9 mm to 62.6±3.9 mm, 60.5±2.9 mm and 59.3±4.2 mm respectively. Previously non-viable areas on DTS were found to contain viable tissue and MRI showed hypokinesia in previously akinetic areas. NYHA class improved to I-II. No significant arrhythmias were noted during the follow-up period. One patient died due to low cardiac output and one patient died due to septic shock.
Conclusions: Combined off-pump surgical treatment and autologous bone-marrow mononuclear cell transplantation for end-stage ischemic cardiomyopathy is safe and feasible and appears to improve the patients’ functional status.

Keywords: ischemic cardiomyopathy, off-pump surgery, cell transplantation


Sotirios Prapas, Dimitrios Protogeros, Fotini Danou, Chrysanthi Trikka, Ioannis Panagiotopoulos, Helen Chandrinou. Effective combined off-pump surgical treatment and autologous bone marrow cell transplantation: a new alternative for patients with end-stage ischemic cardiomyopathy (Prapas’ procedure). Anatol J Cardiol. 2008; 8(Suppl. 2): 101-107

Corresponding Author: Sotirios Prapas, Greece


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