Given the limited treatment options for advanced heart failure, the intrinsic regenerative properties of stem cells have been evaluated for myocardial remodeling. Previous stem cells techniques for myocardiocyte remodeling have been limited by the low cellular retention. Presented is a hybrid approach for remodeling infarcted myocardium through implantation of allogeneic human amniotic fluid–derived mesenchymal stem cells within micronized human allograft-derived liquid matrix during the performance of transmyocardial revascularization (TMR). Given the induced increase in vascular density from TMR, we hypothesize that it may serve as a therapeutic delivery system for stem cell placement into damaged myocardium. We present a patient with ischemic cardiomyopathy and refractory angina, who clinically improved after this hybrid therapy of intraoperative TMR and placement of amniotic fluid–derived mesenchymal stem cells and liquid matrix within the TMR channels. Noninvasive testing of myocardial viability biomarkers utilizing both cardiac magnetic resonance imaging and thallium imaging supported the clinical improvement in cardiac symptom may be related to ventricular remodeling in a region of infarct with subsequent functional improvement.
From the *Department of Medical Imaging, Banner-University Medical Center Tucson, University of Arizona, Tucson, Arizona
†Department of Anesthesiology, Banner-University Medical Center Tucson, University of Arizona, Tucson, Arizona
‡Biltmore Cardiology, Banner-University Medical Center Phoenix, University of Arizona, Phoenix, Arizona
¶University of Arizona Cancer Center, University of Arizona, Tucson, Arizona
‖Department of Physiology, University of Arizona College of Medicine, Tucson, Arizona
#Department of Surgery, Division of Cardiothoracic Surgery, Banner-University Medical Center Tucson, University of Arizona, Tucson, Arizona.
Submitted for consideration August 2017; accepted for publication in revised form October 2017.
Disclosures: The authors have no conflicts of interest.
Correspondence: Ryan Avery, 1501 North Campbell Avenue, PO Box 245068, Tucson, AZ 85724. Email: firstname.lastname@example.org.