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INTRODUCTION: Heart transplantation (HTx) has emerged as a pivotal intervention for end-stage heart failure, offering significant improvements in survival and quality of life. This manuscript elucidates the landscape of HTx across Latin America (LATAM) from its advent in 1968 through December 2022, shedding light on its evolution, current practices, and regional disparities. METHODS: We distributed a structured questionnaire to the national coordinators or representatives of the Interamerican Council of Heart Failure and Pulmonary Hypertension, collating responses from 20 LATAM nations. This approach facilitated a comprehensive aggregation of regional HTx data. RESULTS: A total of 12,374 HTx were performed in 166 centers across 16 LATAM countries, with Brazil, Argentina, and Colombia accounting for the majority of procedures. Pediatric transplants represented 9% of the total caseload, and combined organ transplants were reported in 62.5% of the participating countries, underscoring the complexity and breadth of transplant services in the region. CONCLUSION: Despite facing infrastructural and logistical challenges, LATAM has demonstrated a robust capacity to conduct high-complexity transplant procedures. The establishment of a structured, regional HTx registry is imperative to enhance data collection and analysis, which in turn can inform clinical decision-making and policy development, ultimately improving patient outcomes across the continent.

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BACKGROUND: The COVID-19 pandemic has highlighted a correlation between cardiac complications and elevated cardiac biomarkers, which are linked to poorer clinical outcomes. OBJECTIVE: This study aims to determine the clinical impact of cardiac biomarkers in COVID-19 patients in Latin America. SUBJECTS AND METHODS: The CARDIO COVID 19-20 Registry is a multicenter observational study across 44 hospitals in Latin America and the Caribbean. It included hospitalized COVID-19 patients (n = 476) who underwent troponin, natriuretic peptide, and D-dimer tests. Patients were grouped based on the number of positive biomarkers. RESULTS: Among the 476 patients tested, 139 had one positive biomarker (Group C), 190 had two (Group B), 118 had three (Group A), and 29 had none (Group D). A directly proportional relationship was observed between the number of positive biomarkers and the incidence of decompensated heart failure. Similarly, there was a proportional relationship between the number of positive biomarkers and increased mortality. In Group B, patients with elevated troponin and natriuretic peptide and those with elevated troponin and D-dimer had 1.4 and 1.5 times higher mortality, respectively, than those with elevated natriuretic peptide and D-dimer. CONCLUSIONS: In Latin American COVID-19 patients, a higher number of positive cardiac biomarkers is associated with increased cardiovascular complications and mortality. These findings suggest that cardiac biomarkers should be utilized to guide acute-phase treatment strategies.

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Background: Socioeconomic factors contribute to a more severe impact of COVID-19 in Latin American and Caribbean (LA&C) countries than in developed countries. Patients with a severe or critical illness can develop respiratory and cardiovascular complications. Objective: To describe a LA&C population with COVID-19 to provide information related to this disease, in-hospital cardiovascular complications, and in-hospital mortality. Methods: The CARDIO COVID-19-20 Registry is an observational, multicenter, prospective, and hospital-based registry of patients with confirmed COVID-19 infection that required in-hospital treatment in LA&C. Enrollment of patients started on May 01, 2020, and ended on June 30, 2021. Results: The CARDIO COVID-19-20 Registry included 3260 patients from 44 institutions of 14 LA&C countries. 63.2% patients were male and median age was 61.0 years old. Most common comorbidities were overweight/obesity (49.7%), hypertension (49.0%), and diabetes mellitus (26.7%). Most frequent cardiovascular complications during hospitalization or reported at discharge were cardiac arrhythmia (9.1%), decompensated heart failure (8.5%), and pulmonary embolism (3.9%). The number of patients admitted to the Intensive Care Unit (ICU) was 1745 (53.5%), and median length of their stay at the ICU was 10.0 days. Support required in ICU included invasive mechanical ventilation (34.2%), vasopressors (27.6%), inotropics (10.3%), and vasodilators (3.7%). Rehospitalization after 30-day post discharge was 7.3%. In-hospital mortality and 30-day post discharge were 25.5% and 2.6%, respectively. Conclusions: According to our findings, more than half of the LA&C population with COVID-19 assessed required management in ICU, with higher requirement of invasive mechanical ventilation and vasoactive support, resulting in a high in-hospital mortality and a considerable high 30-day post discharge rehospitalization and mortality.

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RESUMEN Introducción: Diferentes registros argentinos de insuficiencia cardíaca crónica (ICC) fueron generados en los últimos 25 años, en forma individual por la Sociedad Argentina de Cardiología (SAC) y la Federación Argentina de Cardiología (FAC), con diversa representatividad. Los últimos datos conocidos datan de 2013. El Registro OFFICE IC AR fue encarado en forma conjunta por la SAC y la FAC para conocer la realidad de la ICC en Argentina. Objetivos: Describir en forma amplia y comprensiva las características salientes de la ICC en Argentina, incluyendo las características de los pacientes, el uso de recursos diagnósticos y terapéuticos, la adherencia a las guías de práctica y el pronóstico a mediano y largo plazo. Material y Métodos: Estudio prospectivo de cohorte, de pacientes con ICC de al menos 6 meses de evolución, alejados de una internación por al menos 3 meses. Se recabaron datos clínicos y paraclínicos. Los pacientes fueron categorizados, de acuerdo a la fracción de eyección ventricular izquierda (FEVI), en IC con FE reducida, ICFER (≤40%); IC con FE en el rango medio, ICFErm, ahora denominada IC con FE levemente reducida, ICFElr (41%-49%), e IC con FE preservada, ICFEP (≥50%). En seguimiento de al menos 1 año se registró la incidencia de hospitalización por insuficiencia cardíaca (HIC), muerte cardiovascular (MCV) y muerte de todas las causas (MTC) Resultados: Entre noviembre de 2017 y enero de 2020, 100 cardiólogos de todo el país incluyeron 1004 pacientes con ICC; edad media 65,8 ± 12,4 años, 74,6% hombres, FEVI conocida en el 93,8%. El 68,4% tenía ICFER, el 16% ICFElr y el 15,6% ICFEP. Hubo alta prevalencia de comorbilidades, incluyendo diabetes y anemia en el 30%, e insuficiencia renal crónica en el 22%. Fue elevada la utilización de antagonistas neurohormonales (ANH): 89,5% betabloqueantes; 57,3% inhibidores o antagonistas del sistema renina angiotensina, 28,9% sacubitril valsartán y 78,6% antialdosterónicos. En 69% se utilizó triple terapia. Su empleo fue mayor en la ICFER, pero elevado incluso en la ICFEP. En una mediana de seguimiento de 1,7 años la incidencia anual de MCV/HIC fue 12,8%, la de MCV 6,6% y la de MTC 8,4%, sin diferencia entre las distintas categorías de FEVI. Conclusiones: En el primer registro conjunto de ICC SAC-FAC se verificó elevada prevalencia de ICFER, alta prevalencia de comorbilidades, uso frecuente de ANH y pronóstico acorde a los registros internacionales.

ABSTRACT Background: Several Argentine registries on chronic heart failure (CHF) have been generated over the past 25 years, either individually by the Argentine Society of Cardiology (SAC) or the Argentine Federation of Cardiology (FAC), with different representativeness. The last known data are from 2013. The OFFICE IC AR registry was jointly undertaken by the SAC and FAC to know the reality of CHF in Argentina. Objective: The aim of this registry was to extensively and comprehensively describe the outstanding characteristics of CHF in Argentina, including patient characteristics, use of diagnostic and therapeutic resources, adherence to practice guidelines and mid-and long-term prognosis. Methods: This was a prospective cohort study of patients with at least 6-month evolution CHF and not hospitalized for at least the past 3 months. Clinical and paraclinical data were collected. Patients were categorized according to left ventricular ejection fraction (LVEF), into HF with reduced EF, HFrEF (≤40 %), HF with midrange EF, now termed HF with mildly reduced EF, HFmrEF (41%-49%), and HF with preserved EF, HFpEF (≥50%). The incidence of hospitalization for HF (HHF), cardiovascular mortality (CVM) and all-cause mortality (ACM) was recorded for at least 1-year follow-up. Results: Between November 2017 and January 2020, 100 cardiologists from all over the country included 1004 patients with CHF. Mean age was 65.8 ± 12.4 years, 74.6% were men, and 93.8% had known LVEF. In 68.4% of cases, patients had HFrEF, 16% HFmrEF and 15.6% HFpEF. A high prevalence of comorbidities was found, including diabetes and anemia in 30% of cases, and chronic renal failure in 22%. There was high use of neurohormonal antagonists (NHA): 89.5% betablockers, 57.3% renin-angiotensin system inhibitors or antagonists, 28.9% sacubitril-valsartan and 78.6% aldosterone antagonists. Triple therapy was used in 69% of patients, with higher prescription in HFrEF, but elevated even on HFpEF. At a median follow-up of 1.7 years, the annual incidence of CVM/HHF was 12.8%, CVM 6.6% and ACM 8.4%, without statistical differences between the different LVEF categories. Conclusions: This first SAC-FAC joint CHF registry verified a high prevalence of HFrEF, a high prevalence of comorbidities, frequent use of NHA and prognosis according to international registries.

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Background: Infection caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) exhibits a strong infectivity but less virulence compared to severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS). In terms of cardiovascular morbidity, susceptible population include elderly and patients with certain cardiovascular conditions. This infection has been associated with cardiac injury, cardiovascular complications and higher mortality. Objectives: The main objective of the CARDIO COVID 19-20 Registry is to determine the presence of cardiovascular comorbidities and cardiovascular complications in COVID-19 infected patients that required in-hospital treatment in different Latin American institutions. Methods: The CARDIO COVID 19-20 Registry is an observational, multicenter, ambispective, and hospital-based registry of patients with confirmed COVID-19 infection who required in-hospital treatment in Latin America. Enrollment of patients started on May 01, 2020 and was initially planned to last three months; based on the progression of pandemic in Latin America, enrollment was extended until December 2020, and could be extended once again based on the pandemic course in our continent at that moment. Conclusions: The CARDIO COVID 19-20 Registry will characterize the in-hospital population diagnosed with COVID-19 in Latin America in order to identify risk factors for worsening of cardiovascular comorbidities or for the appearance of cardiovascular complications during hospitalization and during the 30-day follow up period.

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OBJECTIVES: The aim was to estimate the risk of dialysis postoperative de novo dialysis in patients undergoing elective cardiac surgery, according to varying degrees of pre-existing renal dysfunction, and to compare the outcomes with the expected prevalence of dialysis based on several risk scores. METHODS: A retrospective analysis was performed over a 5-year period (2012-16) from a series of 1332 adult patients who underwent elective cardiac surgery. Patients were divided into 3 estimated creatinine clearance (eCrCl) groups: eCrCl >60 ml/min, eCrCl from 50 ml/min to 60 ml/min and eCrCl ≤49 ml/min. The primary outcome was any renal failure requiring first-time dialysis during the postoperative hospital stay. The expected risk for postoperative dialysis was calculated with 3 predictive scores: the Society of Thoracic Surgeons Bedside Risk Tool, the Cleveland Clinic Score and the Simplified Renal Index. The global accuracy of eCrCl and the different scores was evaluated in terms of calibration and discrimination. RESULTS: In the overall population, 26.6% of patients presented moderate or severe pre-existing renal dysfunction, and the need for de novo dialysis varied from 0.6% to 5.0% depending on the degree of preoperative eCrCl (P < 0.0001). Preoperative renal dysfunction with eCrCl <50 ml/min was associated with nearly 8-fold increase of risk for postoperative dialysis; eCrCl between 50 ml/min and 60 ml/min showed a 2-fold increase, though this last difference did not reach statistical significance. CONCLUSIONS: In elective cardiac surgery, isolated preoperative eCrCl seemed to be an accurate indicator of risk for postoperative de novo dialysis. More complex models did not provide additional information to stratify that risk.

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The objective of this study was to evaluate the efficacy of age, creatinine and ejection fraction (ACEF) score and the modified ACEFCG model, incorporating creatinine clearance, to predict immediate operative mortality risk of patients undergoing elective cardiac surgery. A retrospective analysis was performed of prospectively collected data between 2012 and 2015, from a series of 1190 adult patients who underwent elective cardiac surgery. Operative risk mortality was assessed with ACEF, ACEFCG and EuroSCORE II. Overall mortality rate was 4.0% (48 cases), while mean mortality rates predicted by ACEF, ACEFCG, and EuroSCORE II were 2.3% (p = 0.014), 6.4% (p = 0.010) and 2.5% (p = 0.038), respectively. Overall observed/predicted mortality ratio was 1.8 for ACEF score, 0.6 for ACEFCG score and 1.6 for EuroSCORE II. The ACEF score demonstrated an adequate overall performance for the low- and intermediate-risk groups, but underestimated mortality for the high risk group. The ACEFCG score discriminatory power systematically improved the area under the ROC curve (AUC) obtained with the ACEF score; however, EuroSCORE II showed the best AUC. Overall accuracy was 56.1% for the ACEF score, 51.2% for the ACEFCG score and 75.9% for EuroSCORE II. For clinical use, the ACEF score seems to be adequate to predict mortality in low- and intermediate-risk patients. Though the ACEFCG score had a better discriminatory power and calibration, it tended to overestimate the expected risk. Since ideally, a simpler risk stratification score should be desirable for bedside clinical use, the ACEF model reasonably met the expected performance in our population.

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The objective of this study was to evaluate the efficacy of age, creatinine and ejection fraction (ACEF) score and the modified ACEFCG model, incorporating creatinine clearance, to predict immediate operative mortality risk of patients undergoing elective cardiac surgery. A retrospective analysis was performed of prospectively collected data between 2012 and 2015, from a series of 1190 adult patients who underwent elective cardiac surgery. Operative risk mortality was assessed with ACEF, ACEFCG and EuroSCORE II. Overall mortality rate was 4.0% (48 cases), while mean mortality rates predicted by ACEF, ACEFCG, and EuroSCORE II were 2.3% (p = 0.014), 6.4% (p = 0.010) and 2.5% (p = 0.038), respectively. Overall observed/predicted mortality ratio was 1.8 for ACEF score, 0.6 for ACEFCG score and 1.6 for EuroSCORE II. The ACEF score demonstrated an adequate overall performance for the low- and intermediate-risk groups, but underestimated mortality for the high risk group. The ACEFCG score discriminatory power systematically improved the area under the ROC curve (AUC) obtained with the ACEF score; however, EuroSCORE II showed the best AUC. Overall accuracy was 56.1% for the ACEF score, 51.2% for the ACEFCG score and 75.9% for EuroSCORE II. For clinical use, the ACEF score seems to be adequate to predict mortality in low- and intermediate-risk patients. Though the ACEFCG score had a better discriminatory power and calibration, it tended to overestimate the expected risk. Since ideally, a simpler risk stratification score should be desirable for bedside clinical use, the ACEF model reasonably met the expected performance in our population.

El objetivo fue evaluar la eficacia de la escala de riesgo de edad, creatinina y fracción de eyección (ACEF) y también ACEFCG, que incorpora la depuración de creatinina, para predecir el riesgo de mortalidad operatoria inmediata tras una cirugía cardiaca electiva. Se realizó un análisis retrospectivo de datos recolectados prospectivamente entre 2012 y 2015, de 1190 adultos sometidos a cirugía cardíaca electiva. El riesgo de mortalidad operatoria se evaluó con ACEF, ACEFCG y EuroSCORE II. La tasa de mortalidad global fue 4.0% (48 casos), mientras que las tasas de mortalidad predichas por ACEF, ACEFCG y EuroSCORE II fueron 2.3% (p = 0.014), 6.4% (p = 0.010) y 2.5% (p = 0.038), respectivamente. La razón mortalidad observada/esperada fue 1.8 para el ACEF, 0.6 para el ACEFCG y 1.6 para el EuroSCORE II. La puntuación de ACEF demostró un desempeño adecuado para los grupos de riesgo bajo y medio, pero subestimó la mortalidad del grupo de alto riesgo. La discriminación del ACEFCG mejoró sistemáticamente el área ROC del ACEF; sin embargo, el EuroSCORE II mostró la mejor área ROC. La precisión global fue 56.1% para el ACEF, 51.2% para el ACEFCG y 75.9% para el EuroSCORE II. Para uso clínico, el modelo ACEF parece ser adecuado para predecir la mortalidad en pacientes de riesgo bajo y medio. Aunque el puntaje de ACEFCG tuvo un mejor poder discriminatorio y calibración, tendió a sobrestimar el riesgo esperado. Considerando que sería ideal contar con un método de estratificación de riesgo más simple para uso clínico al lado de la cama, el modelo ACEF tuvo un desempeño razonable en nuestra población.

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BACKGROUND: Endocardial stimulation of the left ventricle for cardiac resynchronization therapy is a growing field of investigation. Despite the excellent results and absence of significant complications demonstrated thus far in the literature, the lack of a simple, straightforward, and standard technique limits its widespread utilization. OBJECTIVE: To assess the feasibility, safety, simplicity, and complications of a technique for inserting the left ventricle lead through a femoral transseptal sheath to the pectoral implant site, termed "the Jurdham procedure." METHODS: We performed the Jurdham procedure in 10 patients (8 men; 60.5 ± 1.8 years) in whom a coronary sinus lead implant had failed. A snared 85-cm standard active fixation endocardial pacing lead was implanted on the left ventricle endocardium through a femoral transseptal sheath with subsequent mobilization of the proximal end of the lead to the prepectoral area via the snare. RESULTS: Successful implant was achieved in all 10 patients without complications, with excellent acute and chronic pacing parameters. All patients remained on chronic oral anticoagulation therapy without thromboembolic or bleeding complications. No late complications have occurred. All patients have improved at least 1 New York Heart Association functional class and have remained clinically stable during the follow-up term. CONCLUSION: The Jurdham procedure is a reliable, technically easy technique to achieve cardiac resynchronization therapy via the endocardial approach. In our initial experience, there has been an excellent clinical response without significant complications during short-term follow-up. Additional investigation is needed to define the precise indications and limitations of this procedure.

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Objetivos. El trasplante celular para la regeneración del miocardio está limitado por la escasa viabilidad del injerto y la baja retención celular. En la miocardiopatía isquémica la matriz extracelular está profundamente alterada, por consiguiente, sería importante asociar un procedimiento para regenerar las células miocárdicas y restaurar la función de la matriz extracelular. En este estudio clínico, fue evaluada la terapia celular intrainfarto asociada a una matriz de colágeno sembrada con células e implantada sobre ventrículos infartados.Métodos. En 15 pacientes (54,2±3,8 años de edad) que presentaban cicatrices miocárdicas postisquémicas en el ventrículo izquierdo (VI) y con indicación de cirugía de revascularización miocárdica, se implantaron, durante la operación, células de la médula ósea mononucleares autólogas (CMO) en la cicatriz. Se agregó sobre esa zona infartada una matriz de colágeno tipo I con el mismo número de CMO

Resultados. No hubo mortalidad ni eventos adversos relacionados (seguimiento 15±4,2 meses). La clase funcional según la New York Heart Association (NYHA) mejoró de 2,3±0,5 a 1,4±0,3 (p=0,005). El volumen de fin de diástole del VI evolucionó de 142±24 a 117±21 mL (p=0,03), el tiempo de desaceleración del llenado del VI mejoró aumentando de 162±7 mseg a 196±8 mseg (p=0,01). El espesor del área cicatrizada progresó de 6±1,4 a 9±1,5 mm (p=0,005). La fracción de eyección (FE) mejoró de 25±7 a 33±5% (p=0,04).Conclusiones. La inyección intramiocárdica de células de médula ósea y la fijación simultánea de una matriz sembrada con progenitores celulares (stem cells) sobre el epicardio fue simple y sin complicaciones. La matriz de colágeno aumento el espesor de la zona del infarto con nuevos tejidos viables, limitando la dilatación ventricular y mejorando la función diastólica. Estos resultados positivos no pueden ser absolutamente relacionados a las células y la matriz, pues se asociaron puentes de revascularización coronaria. En conclusión, la ingeniería de tejidos puede extender las indicaciones y beneficios de la terapia con células madre en cardiología, convirtiéndose en un camino prometedor para la creación de un “miocardio bioartificial”

Objectives. Stem cell therapy for myocardial regeneration is limited by poor graft viability and low cell retention. In ischemic cardiomyopathy the extracellular matrix is pathologically modified, therefore it could be important to associate a procedure aiming at regenerating both, myocardial cells and the extracellular matrix. We evaluated intrainfarct cell therapy associated with a cell-seeded collagen scaffold grafted onto infarcted hearts.Methods. In 15 patients (aged 54.2±3.8 years) presenting LV postischemic myocardial scars and with indication for a single off-pump-CABG, autologous mononuclear bone marrow cells (BMC) were implanted during surgery in the scar. A 3D collagen type I matrix seeded with the same number of BMC was grafted onto the infarction zone.Results. There was no mortality and any related adverse events (follow-up 15±4.2 months). NYHA FC improved from 2.3±0.5 to 1.4±0.3 (p=0.005). LV end-diastolic volume evolved from 142±24 to 117±21 mL (p=0.03), LV filling deceleration time improved from 162±7 ms to 196±8 ms (p=0.01). Scar area thickness progress from 6±1.4 to 9±1.5mm (p=0.005). EF improved from 25±7 to 33±5% (p=0.04).Conclusions. Simultaneous intramyocardial injection of mononuclear bone marrow cells and fixation of a BMC-seeded matrix onto the epicardium is feasible and safe. The cell seeded collagen matrix seems to increase the thickness of the infarct scar with viable tissues and help to normalize cardiac wall stress in injured regions, thus limiting ventricular remodelling and improving diastolic function. Patients’ improvements can not be conclusively related to the cells and matrix due to the association of CABG. Cardiac tissue engineering should extend the indications and benefits of stem cell therapy in cardiology, becoming a promising way for the creation of a “bioartificial myocardium”

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Objetivo La presente investigación clínica persigue evaluar la seguridad y la factibilidad del cardioimplante de células mononucleares de médula ósea, así como analizar los cambios clínicos y de la función ventricular, en pacientes portadores de insuficiencia cardíaca secundaria a miocardiopatía dilatada de origen chagásico sometidos a este procedimiento. Material y métodos La muestra comprende 5 pacientes consecutivos (3 masculinos) con una edad promedio de 55,8 ± 8,1 años, que presentaban insuficiencia cardíaca secundaria a miocardiopatía chagásica. Los datos preoperatorios promedio de estos pacientes indicaban una clase funcional (NYHA) de 2,6 ± 0,5, mientras que la fracción del ventrículo izquierdo correspondía al 27,6% ± 5,9%, el diámetro diastólico ventricular izquierdo era de 62,9 ± 6,2 mm y el diámetro sistólico del ventrículo izquierdo era de 49,7 ± 7,6 mm. La suspensión celular obtenida de células mononucleares de la médula ósea contenía 10,6 ± 7 ml con un conteo de 1,43 ± 0,6 (E+08) células con una viabilidad mayor del 95%. Correspondían a la fracción CD34+, 5,07 ± 9,51 (E+06) y a la CD133+, 5,11 ± 4,3 (E+06). La suspensión se inyectó por pulsos en cuatro pacientes por vía intracoronaria y en el quinto por vía transepicárdica en el transcurso de una cirugía (reemplazo valvular mitral, revascularización y colocación de matriz bioartificial degradable). Resultados A los 17,2 ± 8,8 meses de seguimiento promedio, 4 enfermos se hallaban vivos y en clase funcional I (p < 0,005). Un paciente falleció de muerte súbita a los 17 meses de seguimiento. En este tiempo de evolución no se observaron efectos adversos en ninguno de los pacientes referidos al implante celular. En relación con la fracción de eyección, se notó un incremento a 36,6% ± 2,3% (p < 0,05). Los datos obtenidos en la medición de los diámetros sistólico y diastólico del ventrículo izquierdo no mostraron cambios estadísticos significativos. Conclusiones Este trabajo representa la segunda comunicación mundial sobre el uso de stem cells en cardiopatía de Chagas-Mazza. El procedimiento resultó factible y seguro y se asoció con mejoría de la capacidad funcional y de la función ventricular en el seguimiento. Estos hallazgos provisorios deberán ser corroborados por estudios clínicos controlados más amplios.

Objective The present clinical study is aimed at assessing the safety and feasibility of cardio implantation of mononuclear bone marrow cells, as well as analyzing the clinical and ventricular function changes in patients with cardiac failure secondary to dilated myocardial disease of chagasic origin that underwent this procedure. Material and Methods The sample included 5 consecutive patients (3 male), mean age 55, 8 ± 8, 1 years that showed cardiac failure secondary to chagasic myocardial disease. Average pre-surgery data in these patients were 2, 6 ± 0, 5 functional class (NYHA), whereas the left ventricle fraction corresponded to 27, 6% ± 5, 9%, the left ventricle diastolic diameter was 49, 7 ± 7, 6 mm. The cellular suspension obtained from mononuclear bone marrow cells contained 10, 6 ± 7 ml with 1, 43 ± 0, 6 (E+08) cell counting with a viability higher than 95%. Corresponding to CD34+, 5, 07 ± 9, 51 (E+06) fraction and CD133+, 5, 11 ± 4, 3 (E+06). Suspension was intracoronary injected in pulses to four patients and transepicardially to the fifth during the course of a surgery (mitral valve replacement, revascularization and degradable bioartificial matrix). Results At 17,2 ± 8,8 average months follow up, 4 patients were alive and with functional class I (p < 0,005). One patient died of sudden death after 17 months of follow up. During this evolution time period no adverse events were observed in none of the patients referred for cellular implantation. In regards to the ejection fraction, a 36,6% ± 2,3% (p < 0,05) increase was observed. Data obtained from the assessment of the left ventricle systolic and diastolic diameters did not show significant statistical changes. Conclusions This study represents the second world communication on the use of stem cells in Chagas-Mazza heart disease. The procedure resulted feasible and safe and was associated to improvement of the functional capacity and ventricular function during follow up. These conditional results should be corroborated by broader controlled clinical trials.

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Cell transplantation for the regeneration of ischemic myocardium is limited by poor graft viability and low cell retention. In ischemic cardiomyopathy the extracellular matrix is deeply altered; therefore, it could be important to associate a procedure aiming at regenerating myocardial cells and restoring the extracellular matrix function. We evaluated intrainfarct cell therapy associated with a cell-seeded collagen scaffold grafted onto infarcted ventricles. In 15 patients (aged 54.2 +/- 3.8 years) presenting LV postischemic myocardial scars and with indication for a single OP-CABG, autologous mononuclear bone marrow cells (BMC) were implanted during surgery in the scar. A 3D collagen type I matrix seeded with the same number of BMC was added on top of the scarred area. There was no mortality and no related adverse events (follow-up 15 +/- 4.2 months). NYHA FC improved from 2.3 +/- 0.5 to 1.4 +/- 0.3 (p = 0.005). LV end-diastolic volume evolved from 142 +/- 24 to 117 +/- 21 ml (p = 0.03), and LV filling deceleration time improved from 162 +/- 7 to 196 +/- 8 ms (p = 0.01). Scar area thickness progressed from 6 +/- 1.4 to 9 +/- 1.5 mm (p = 0.005). EF improved from 25 +/- 7% to 33 +/- 5% (p = 0.04). Simultaneous intramyocardial injection of mononuclear bone marrow cells and fixation of a BMC-seeded matrix onto the epicardium is feasible and safe. The cell-seeded collagen matrix seems to increase the thickness of the infarct scar with viable tissues and helps to normalize cardiac wall stress in injured regions, thus limiting ventricular remodeling and improving diastolic function. Patients' improvements cannot be conclusively related to the cells and matrix due to the association of CABG. Cardiac tissue engineering seems to extend the indications and benefits of stem cell therapy in cardiology, becoming a promising way for the creation of a "bioartificial myocardium." Efficacy and safety of this approach should be evaluated in a large randomized controlled trial.

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Este trabajo se analiza como una continuación de una de las primeras experiencias publicadas en el mundo sobre implante clínico de células con mioblastos, cuyos resultados fueron editados en este mismo órgano de difusión. Si tomamos en cuenta los segmentos comprometidos y los dividimos en infarto transmural, infarto no transmural, isquémicos y normales, hallamos que sobre 68 segmentos pasibles de estudio en los 4 enfermos sobrevivientes a los 33 ± 6,05 meses hubo un claro retroceso de los segmentos con infarto transmural y un incremento en los segmentos no transmurales e isquémicos. En los segmentos con compromiso transmural, éstos retrocedieron de 15 a 3, lo cual representa una reducción del 80 por ciento (p = 0,0005). El análisis de los segmentos no transmurales debe ser exhaustivo. Si bien globalmente aumentaron de 7 a 10, los segmentos no transmurales registrados originariamente en el preoperatorio descendieron de 7 a 2, un 72 por ciento. El aumento global de estos segmentos no transmurales puede explicarse por los segmentos incorporados tanto por el avance de la enfermedad como a expensas de los transmurales, en claro retroceso del tejido fibrótico.

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Este trabajo se analiza como una continuación de una de las primeras experiencias publicadas en el mundo sobre implante clínico de células con mioblastos, cuyos resultados fueron editados en este mismo órgano de difusión. Si tomamos en cuenta los segmentos comprometidos y los dividimos en infarto transmural, infarto no transmural, isquémicos y normales, hallamos que sobre 68 segmentos pasibles de estudio en los 4 enfermos sobrevivientes a los 33 ± 6,05 meses hubo un claro retroceso de los segmentos con infarto transmural y un incremento en los segmentos no transmurales e isquémicos. En los segmentos con compromiso transmural, éstos retrocedieron de 15 a 3, lo cual representa una reducción del 80 por ciento (p = 0,0005). El análisis de los segmentos no transmurales debe ser exhaustivo. Si bien globalmente aumentaron de 7 a 10, los segmentos no transmurales registrados originariamente en el preoperatorio descendieron de 7 a 2, un 72 por ciento. El aumento global de estos segmentos no transmurales puede explicarse por los segmentos incorporados tanto por el avance de la enfermedad como a expensas de los transmurales, en claro retroceso del tejido fibrótico. (AU)

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Este trabajo se analiza como una continuación de una de las primeras experiencias publicadas en el mundo sobre implante clínico de células con mioblastos, cuyos resultados fueron editados en este mismo órgano de difusión. Si tomamos en cuenta los segmentos comprometidos y los dividimos en infarto transmural, infarto no transmural, isquémicos y normales, hallamos que sobre 68 segmentos pasibles de estudio en los 4 enfermos sobrevivientes a los 33 ± 6,05 meses hubo un claro retroceso de los segmentos con infarto transmural y un incremento en los segmentos no transmurales e isquémicos. En los segmentos con compromiso transmural, éstos retrocedieron de 15 a 3, lo cual representa una reducción del 80 por ciento (p = 0,0005). El análisis de los segmentos no transmurales debe ser exhaustivo. Si bien globalmente aumentaron de 7 a 10, los segmentos no transmurales registrados originariamente en el preoperatorio descendieron de 7 a 2, un 72 por ciento. El aumento global de estos segmentos no transmurales puede explicarse por los segmentos incorporados tanto por el avance de la enfermedad como a expensas de los transmurales, en claro retroceso del tejido fibrótico. (AU)

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