Therapeutic angiogenesis with basic fibroblast growth factor: Technique and early results
Therapeutic angiogenesis with basic fibroblast growth factor: Technique and early results
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DOI：
10.1016/s0003-4975(98)00340-3
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发表时间：
1998-06-01
影响因子：
4.6
通讯作者：
Simons, M
中科院分区：
文献类型：
--
作者：
Sellke, FW;Laham, RJ;Simons, M
背景资料。无法通过常规方法完成心肌血管重建术的患者是一个棘手的临床问题。在这里，我们介绍了使用肝素-海藻酸盐缓释装置在冠状动脉搭桥术患者中应用碱性成纤维细胞生长因子诱导侧支生长的早期结果和技术考虑。8名患者入选。如果患者至少有一支可移植的冠状动脉阻塞，至少有一条主要动脉分布不适合血运重建，血清肌酐水平低于3 mg/dL，射血分数大于0.20，并且估计手术死亡率低于25%，则患者是候选患者。在常规冠状动脉搭桥术中，10个肝素-海藻酸盐装置被植入到心外膜脂肪中，每个装置含有1mg10mg碱性成纤维细胞生长因子，位于不可血运重建区的多个区域以及移植动脉或通畅动脉的远端分布。在随访期间没有死亡，也没有肾、血液或肝脏毒性的证据。手术三个月后，所有患者都没有心绞痛。对7例患者进行了负荷灌注扫描。3例未血运重建的心肌有明显的血流灌注增强，1例有新的固定缺陷，3例有微小的整体改变，但有新的小的、固定的灌注缺陷的证据。7例患者心肌收缩功能改善或相似(术后3个月随访射血分数=0.53+/-0.22，术前为0.47+/-0.14)。1例患者围手术期因应用碱性成纤维细胞生长因子而发生心肌梗死。这项初步研究证明了肝素-海藻酸盐缓释装置应用碱性成纤维细胞生长因子治疗血管生成的安全性和技术可行性。对安全性、临床疗效和长期结果的进一步研究正在进行中。(C)1998年由胸外科医生学会颁发。
Background. Patients not amenable to complete myocardial revascularization by conventional methods present a difficult clinical problem. Here we present the early results and technical considerations of the administration of basic fibroblast growth factor for the induction of collateral growth using heparin-alginate slow-release devices in patients undergoing coronary artery bypass grafting.Methods. Eight patients were enrolled. Patients were candidates if they had at least one graftable obstructed coronary artery and at least one major arterial distribution not amenable to revascularization, a serum creatinine level less than 3 mg/dL, ejection fraction greater than 0.20, and estimated operative mortality of less than 25%. During conventional coronary artery bypass grafting, 10 heparin-alginate devices, each containing either 1 mu g or 10 mu g of basic fibroblast growth factor, were implanted in the epicardial fat in multiple regions of the unrevascularizable territory and also in the distal distribution of a grafted or patent artery.Results. There was no mortality and no evidence of renal, hematologic, or hepatic toxicity during follow-up. Three months after the operation, all patients remain free of angina. Seven patients were examined with stress perfusion scans. Three patients had clear enhancement of perfusion to the unrevascularized myocardium, 1 patient had a new fixed defect, and 3 had minimal overall change but had evidence of new small, fixed perfusion defects. Seven patients had improved or similar myocardial contractile function (ejection fraction at 3-month followup = 0.53 +/- 0.22 versus 0.47 +/- 0.14 preoperatively). One patient suffered a perioperative myocardial infarction in the area of basic fibroblast growth factor administration.Conclusions. This preliminary study demonstrates the safety and technical feasibility of therapeutic angiogenesis with basic fibroblast growth factor delivered by heparin-alginate slow-release devices. Further studies examining the safety, clinical efficacy, and long-term results are ongoing. (C) 1998 by The Society of Thoracic Surgeons.