Clinical trial NCT02870933: Transepicardial With Transseptal Autologous CD 133+ Bone Marrow Cell Implantation in Patient Following CABG Surgery
Official title: The Effect of Transepicardial Augmentation on Transseptal Autologous CD 133+ Bone Marrow Cell Implantation to Myocardial Perfusion in Patient Following Coronary Artery Bypass Grafting
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Coronary Artery Disease
Keywords: CD 133+
Transepicardial with Transseptal Implantation
CABG
Lead sponsor: National Cardiovascular Center Harapan Kita Hospital Indonesia
Sponsor class: OTHER
First posted: 2016-08-17
Enrollment: 30
Sex: ALL
Minimum age (years): 40
Maximum age (years): 70
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Heart Failure has several etiologies and one of them is coronary artery disease. Coronary artery bypass grafting (CABG) is one of revascularizations method which has been used for decades in coronary artery disease theraphy. However, data about coronary artery bypass grafting shows that post-CABG patients still have low ejection fraction. For the last decade, there have been a lot of studies about the using of stem cells to increase heart contractility and reverse the heart remodelling process. In this study, we use CD 133+ bone marrow stem cells which has been proved to have higher angiogenesis potential. The stem cells is given during CABG by injection transepicardial and transseptal. The purpose of this study is to determine whether transpicardial and transseptal injection of CD 133+ bone marrow stem cells can improve myocardial perfusion in patient with low ejection fraction following CABG surgery.

Detailed description: Study sample : patient with low ejection fraction indicated for CABG surgery in NCCHK who fulfill inclusion and exclusion criteria

Sampling method : first we use consecutive method to find subject with male sex and age 40-70. After that, we use simple random sampling to allocate each subject to each group.

Total samples is 13 for each group. To anticipated drop out rate 10%, total sample is 15 for each group.

Intervention and measurement :

Control group will only receive CABG surgery. Study group will receive CBAG surgery and stem cell implantation. Stem cell aspiration will be performed 1 day before CABG procedure. Before aspiration, patients will be given local anesthetic and light sedation. Stem cell will be collected from posterior iliac crest. Total aspirate 190 cc. Stem cell CD133+ will be separated using CliniMACS® Magnetic Separation Device after labelled with Magnetic microbeads - anti CD133 labelling.

Myocardial perfusion reserve index will be measure using MRI. MPRI value will be obtained globally and segmentally in each 16 ventricle segments VEGF plasma level will be measured using sandwich Enzyme-linked Immunosorbent Assay method.

Ejection fraction, left ventricle dimension, and scar size will be measured using MRI.

Quality of life will be measured using Minnesota Living With Heart Failure Questionnaire.

Statistical analysis is done using IBM SPSS Statistics version 21.0 (SPSS inc, Chicago, IL, USA). Numerical data will be presented in either mean/standard deviation or median/min-max depend on distribution of data. Hypothesis test for numeric variable is done using paired/non-paired T test or Mann-Whitney/Wilcoxon depend on normality of data. Normality test is done using Shapiro-Wilk test. Hypothesis test for category varible is done using chi-square or fischer test.

Eligibility criteria: Inclusion Criteria:

* patients with coronary artery disease 3 vessels disease indicated for CABG
* LVEF \< 35% which has been confirmed by MRI
* Patients with akinetic or hypokineic segment, and left ventricle myocardial hypoperfusion confirmed in MRI
* has signed informed consent

Exclusion Criteria:

Emergency CABG Ungraftable coronary artery Acute myocardial Infarct (\<14 days) Valve disease which need surgery repair Contraindicated for MRI High degree ventricular arrhytmia Coagulation disorder HIV positive patient, Hepatitis B + patients, HCV + patients AST/ALT \> 1,5 upper normal value Creatinine \> 2 g/dl. Malignancy

Drop out criteria :

Aortic cross clamp \>120 minutes and CABG total time \>180

Primary outcomes:
measure: Myocardial Defect Perfusion
timeFrame: Baseline, 6 months
measure: Left Ventricular Ejection Fraction
timeFrame: Baseline, 6 months
Secondary outcomes:
measure: Six Minutes Walking Test
timeFrame: Baseline, 6 months
measure: Wall Motion Score Index
timeFrame: Baseline, 6 months
measure: Myocardial Scar Size
timeFrame: Baseline, 6 months
measure: Vascular Endothelial Growth Factor
timeFrame: Baseline, 6 months
measure: Left Ventricle End Systolic Volume
timeFrame: Baseline, 6 months
measure: Minnesota Living With Heart Failure Questionnaire
timeFrame: Baseline, 6 months
measure: Left Ventricle End Diastolic Volume
timeFrame: Baseline, 6 months
Other outcomes:
Locations:
city: Jakarta
country: Indonesia
facility: National Cardiovascular Center Harapan Kita
state: DKI Jakarta
Study officials:
affiliation: National Cardiovascular Center Harapan Kita
name: Tri Wisesa Soetisna, MD, MHA
role: PRINCIPAL_INVESTIGATOR
References: