Cardiology in the Young

Original Article

Intracoronary bone marrow cell application for terminal heart failure in children

Stefan Ruppa1, Christian Juxa1, Halvard Böniga2, Jürgen Bauera1, Torsten Tonna2*, Erhard Seifrieda2, Stefanie Dimmelera3, Andreas M. Zeihera3 and Dietmar Schranza1 c1

a1 Pediatric Heart Center, Justus-Liebig University Giessen, Giessen, Germany

a2 German Red Cross Blood Service Baden–Württemberg–Hessen and Institute for Transfusion Medicine and Immunohaematology, Goethe University Frankfurt, Frankfurt, Germany

a3 Department of Cardiology, Goethe University Frankfurt, Frankfurt, Germany

Abstract

Introduction In spite of tremendous progress in the medical and surgical treatment of children with congenital heart disease and dilated cardiomyopathy achieved during the past few decades, for some children a heart transplant remains the only option. Clinically relevant benefits of intracoronary injection of autologous stem cells on cardiac function and remodelling have been demonstrated in adult patients with acute myocardial infarction. Experience with autologous stem cell therapy in children with severe congenital or acquired pump failure is limited to a small number of case reports.

Method and results Between 2006 and 2010, nine severely ill children were treated with intracoronary infusion of autologous bone marrow-derived mononuclear cells as part of a compassionate therapy in our centre. No procedure-related unexpected adverse events occurred. There was one patient on extracorporeal membrane oxygenation who died of haemorrhage unrelated to the procedure; three patients proceeded to heart transplantation once a donor heart became available. The other five patients showed an improvement with respect to New York Heart Association classification (greater than or equal to 1), brain natriuretic peptide serum levels, and ejection fraction.

Conclusion Similar to adults, intracoronary injection of autologous bone marrow cell is technically feasible and safe for children. On the basis of our data, we propose to perform a pilot study for children with congestive heart failure, to formally assess the efficacy of intracoronary autologous bone marrow cell therapy.

(Received July 31 2011)

(Accepted December 20 2011)

(Online publication February 13 2012)

Correspondence:

c1 Correspondence to: Professor Dr D. Schranz, MD, Pediatric Heart Center, Justus-Liebig University, Feulgenstrasse 12, 35385 Giessen, Germany. Tel: 049 641 9943461; Fax: 049 641 9943469; E-mail: Dietmar.Schranz@paediat.med.uni-giessen.de

Footnotes

* Institute for Transfusion Medicine, German Red Cross Blood Donor Service East, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.