Author + information
- 1Division of Cardiac Surgery, Department of Cardiovascular Diseases, the First Affiliated Hospital of Sun-Yat-sen University
- 2Division of Obstetrics and Gynecology, the First Affiliated Hospital of Jinan University
- 3Division of Laboratory of Respiratory, Department of Respiratory Diseases, the First Affiliated Hospital of Guangzhou Medical University
- 4Division of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center
Stem cell therapy combined with coronary artery bypass grafting (CABG) as an option for regenerative therapy in ischemic heart disease (IHD) was evaluated in a few studies. No consistent conclusions were reached regarding salubrious effects in enhancing heart function, remodeling and improving outcomes. Our aim was to provide a pooled analysis on the safety and potential benefit of stem cell therapy during CABG.
Relevant studies published before April 2016 were collected in a number of databases and analyzed with RevMan 5.3 and SPSS 19.0. Primary outcomes were all-cause mortality and left ventricular ejection fraction (LVEF). Secondary outcomes included stroke, ventricular tachycardia (VT)/ventricular fibrillation (VF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and wall motion index score (WMIS).
Eighteen studies (11 randomized controlled trials, 7 observational studies) with 741 patients were included. Pooled analysis showed the bone marrow-derived stem cells (BMDSC) transplantation significantly, but moderately, improved LVEF in the short-term (4.74%, 95% CI: 2.98%-6.50%, P<0.00001) and long-term follow-up (4.69%, 95% CI: 2.13%-7.25%, P=0.0003). Patients using bone marrow mononuclear cell may have greater LVEF improvement than those using CD133+ cell (WMD 5.01%, 95% CI: 3.27%-6.76%, P<0.00001; WMD 2.72%, 95% CI: -1.13%-6.57%, P=0.17). Moreover, the pooled results showed a significant difference in the mean LVESV (-10.03 ml, 95% CI: -16.46 ml to -3.60 ml, P=0.002), LVEDV (-10.92 ml, 95% CI: -19.96 ml to -1.88 ml, P=0.02) and WMIS (-0.21, 95% CI: -0.32 to -0.09, P=0.003) in favour of BMDSC therapy. BMDSC-based therapies were generally safe as treatment for IHD patients undergoing CABG, however the use of smooth muscle cell in these patients increased the risk of VT/VF (RR 5.583, 95% CI: 1.157-26.932, P=0.025) and all-cause mortality (RR 5.333, 95% CI: 1.575-18.065, P=0.005).
Bone marrow derived stem cell therapies are generally safe and have a clinical benefit on IHD patients undergoing CABG in the short-term and long-term follow-up.