Phase I Safety and Feasibility Study of Intracoronary Delivery of Autologous Bone Marrow Derived Mononuclear Cells

The objective of this study is to determine the safety and feasibility of autologous mononuclear cells (MNC) collected from bone marrow (BM) and intracoronary delivery for individuals with declining performance of their single right ventricle systemic pumps. This procedure has the potential to foster a new strategy for congenital heart patients. This is an open-label study of autologous MNC derived from bone marrow with a 2-year follow-up to document 1) related serious adverse events and 2) monitor changes in cardiac structure and function.

This study is an open label Phase I trial to determine the safety and feasibility of bone marrow-derived mononuclear cells delivered into the coronary circulation of subjects with Fontan circulation and right ventricular dysfunction. Subjects will be screened at outpatient clinic visits at Mayo Clinic and interested qualified subjects will be consented and offered participation in this trial. Once informed consent has been obtained; preoperative values will be established and a selection committee will review subjects within three days prior to planned procedure to confirm inclusion and exclusion criteria. This will require a non-study cardiologist to review the clinical case and confirm the baseline cardiac function with evidence of disease progression with right ventricle dysfunction. However, individuals with decreased cardiac function requiring inotropic support and immediate listing for cardiac transplantation will NOT be included such that the risk of this research procedure may not be acceptable. Following cell-based product delivery, subjects will be followed for 6-months according to a pre-determined schedule that includes imaging studies along with questionnaires, electrophysiology and laboratory studies. Subjects will be contacted for an additional 18-months for surveillance by phone.

Eligibility Criteria:
Inclusion Criteria:

* Individuals with Fontan circulation with right ventricular dysfunction
* Ejection fraction equal to or less than 40% despite optimal outpatient medical management for at least 3 months
* Able to undergo bone marrow aspirate according to clinical consultation with hematology (INR must be maintained at or below 1.5)
* Able to undergo an MRI or CT examination

Exclusion Criteria:

* Individuals or parents of minors unwilling to consent to participation
* Individuals with severe chronic diseases, extra-cardiac syndromes, or cancer
* Females 10 years and older with positive pregnancy test or lack of effective birth control method
* Individuals currently requiring IV inotropes
* Individuals with bleeding disorders or history of thrombosis
* Individuals not eligible for MRI and have elevated serum creatinine level (eGFR less that 45 mL/min) and therefore cannot have a CT examination
* Individuals not eligible for MRI and have a prior significant reaction to intravenous contrast required for CT examination
* Individuals with the following conditions within 60 days prior to procedure:

  * Cardiogenic shock or extracorporeal circulation;
  * New arrhythmia that required medication for control;
  * Documented infection requiring treatment with antibiotics, and/or current infection being treated with antibiotics;
  * Cardiac condition requiring emergency procedure;
  * Cardiovascular surgery;
  * Seizures or history of significant neurological injury;
  * Multi-system organ failure including acute or chronic renal failure