Techniques of myocardial biologic delivery

Summary

The primary objective of biologic therapy including stem cell based cardiovascular regenerative approach is to aid structural and functional repair of the myocardium. To date, overall clinical experience indicates that this therapy is feasible and safe. Structural and functional benefits remain overall neutral with signals of efficacy in well-defined patient cohorts. A reoccurring pitfall appears to be variable biodistribution and low rates of cell retention by the recipient myocardial tissue. Furthermore, clinical studies indicate a progressive decline in myocardial signals after delivery of labelled stem cells, a finding consistent with rapid cell death or washout within hours of administration. Ongoing debate exists as to the most appropriate technique or device for stem cell delivery. The selection depends on the assessment of the underlying pathology, the acuteness of myocardial injury or associated interventional procedure as well as the actual cell type to be delivered. Whilst in the setting of STEMI, intracoronary cell transfer is preferred, direct endomyocardial delivery is the method of choice as a stand-alone procedure in ischemic heart failure. This chapter describes in detail the respective strategies and devices used for cell delivery as well as novel approaches to improve cell retention.

Introduction

Biologic -based cardiac regenerative therapies...