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This study aims to evaluate the safety and clinical feasibility of epicardially delivered autologous atrial appendage micrografts in the treatment of heart failure. The micrografts consisting atrial-derived cells and their extracellular matrix, are placed on an infarction scar during CABG surgery.
The atrial appendages are a tissue reservoir for cardiomyocyte stem and precursor cells. During coronary artery bypass graft (CABG) surgery part of the right atrial appendage can be excised upon insertion of the right atrial cannula of the heart-lung machine. This study aims to address the surgical feasibility and patient safety of epicardially delivered atrial appendage micrografts during CABG surgery.
Autologous cardiac cells are harvested from right atrial appendage during CABG of six patients. Micrografts consisting atrial appendage-derived cells (AADCs) and their extracellular matrix (ECM) of the atrial appendage are mechanically processed. The cells are placed on a tissue-engineered sheet with fibrin gel and tissue clue and further delivered epicardially on top of a infarction scar. Parameters including echocardiography reflecting cardiac insufficiency are studied pre- and post-operatively as well as at three and six months of the follow-up. Cardiac functional magnetic resonance imaging is performed preoperatively and at six-months follow-up. 20 patients will be recruited to serve as a control group. They are scheduled for elective CABG and are treated according to the normal hospital protocol, without the ECM sheet.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AACD-Therapy group | Experimental | 6 patients are recruited to the AADC-therapy group. Autologous atrial appendage derived cells (AADCs) are harvested from the appendage tissue removed during the venal cannulation of bypass. The cells and their extracellular matrix are placed with tissue clue to Cormatrix-sheet and further on top of the myocardium in the area of infarction scar. The procedure is done simultaneously with CABG surgery. The patients will be carefully monitored after the operations and cardiac MRI and echocardiogram will be performed previously to surgery as well as during the follow ups. |
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| Control group | Active Comparator | 20 patients are recruited to form the control group. They are patients scheduled for elective CABG surgery and they meet the same inclusion and exclusion criteria as the therapy group. There patients are followed as the hospital protocol with out any additional imagination or blood tests. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CABG surgery | Procedure | Elective CABG surgery |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Safety; need for vasoactive medication | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; cardiac index in l/min/m | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; hemoglobin in g/l | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; oxygen saturation in the pulmonary arterial blood (SvO2) in % | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; serum potassium level in mmol/l | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; blood glucose level in mmol/l | For assessing haemodynamics during the operation and at the intensive care unit | 6 months |
| Safety; Left ventricular ejection fraction (EF) in % | For assessing cardiac function during and after the operation by echocardiogram | 6 months |
| Safety; pericardial effusion in mm |
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular wall thickness | Measured by MRI | 6 months |
| Change in the amount of myocardial scar tissue | Measured by MRI | 6 months |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ari Harjula, Prof | Heart and Lung Center, Helsinki University Hospital | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Annu Nummi | Helsinki | 00029 | Finland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25142068 | Background | Lehtinen M, Patila T, Vento A, Kankuri E, Suojaranta-Ylinen R, Poyhia R, Harjula A; Helsinki BMMC Collaboration. Prospective, randomized, double-blinded trial of bone marrow cell transplantation combined with coronary surgery - perioperative safety study. Interact Cardiovasc Thorac Surg. 2014 Dec;19(6):990-6. doi: 10.1093/icvts/ivu265. Epub 2014 Aug 20. | |
| 25762563 |
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| ID | Term |
|---|---|
| D006333 | Heart Failure |
| ID | Term |
|---|---|
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| AADC therapy |
| Procedure |
Atrial appendage derived cells are placed on the site of a infarct scar with matrix sheet |
|
For assessing cardiac function after the operation by echocardiogram
| 6 months |
| Safety: telemetric monitoring of rhythm | For assessing cardiac function after the operation | 6 months |
| Feasibility: Success in completing the delivery of the cell sheet to the myocardium | Measured in 0= success, 1= no success | 6 months |
| Feasibility: Waiting time in minutes for the cell sheet | Waiting time in minutes for the finished cell sheet to be placed on the myocardium after doing all the required anastomoses | 6 months |
| Feasibility: Waiting time in minutes for the heart | Waiting time in minutes for the the heart after doing all the anastomoses and before the cell sheet is finished | 6 months |
| Feasibility: Closing the right atrial appendage | Closing the right atrial appendage after removing the standardized tissue piece for preparing the cell sheet. According to the hospital protocol, appendage is closed with purse string suture. 0 = no additional suturing needed, 1 = additional suturing needed. | 6 months |
| Change in left ventricular ejection fraction | Measured by MRI | 6 months |
| Plasma concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels | 6 months |
| New York Heart Association class | 6 months |
| Days in hospital | 1 month |
| Changes in the quality of life. | measured by questionnaire | 6 months |
| Change in movement and diastolic function of left ventricular wall | Measured by MRI | 6 months |
| Local changes in systolic and diastolic function | Measured by echocardiogram | 3 months |
| Lehtinen M, Schildt J, Ahonen A, Nikkinen P, Lauerma K, Sinisalo J, Kankuri E, Vento A, Patila T, Harjula A; Helsinki BMMC Collaboration. Combining FDG-PET and 99mTc-SPECT to predict functional outcome after coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging. 2015 Sep;16(9):1023-30. doi: 10.1093/ehjci/jev032. Epub 2015 Mar 9. |
| 25797522 | Background | Lehtinen M, Patila T, Kankuri E, Lauerma K, Sinisalo J, Laine M, Kupari M, Vento A, Harjula A; Helsinki BMMC Collaboration. Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up. J Heart Lung Transplant. 2015 Jul;34(7):899-905. doi: 10.1016/j.healun.2015.01.989. Epub 2015 Feb 7. |
| 26725880 | Background | Lampinen M, Vento A, Laurikka J, Nystedt J, Mervaala E, Harjula A, Kankuri E. Rational Autologous Cell Sources For Therapy of Heart Failure - Vehicles and Targets For Gene and RNA Therapies. Curr Gene Ther. 2016;16(1):21-33. doi: 10.2174/1566523216666160104141809. |
| 34595223 | Derived | Nummi A, Mulari S, Stewart JA, Kivisto S, Teittinen K, Nieminen T, Lampinen M, Patila T, Sintonen H, Juvonen T, Kupari M, Suojaranta R, Kankuri E, Harjula A, Vento A; AADC consortium. Epicardial Transplantation of Autologous Cardiac Micrografts During Coronary Artery Bypass Surgery. Front Cardiovasc Med. 2021 Sep 14;8:726889. doi: 10.3389/fcvm.2021.726889. eCollection 2021. |
| 29276625 | Derived | Nummi A, Nieminen T, Patila T, Lampinen M, Lehtinen ML, Kivisto S, Holmstrom M, Wilkman E, Teittinen K, Laine M, Sinisalo J, Kupari M, Kankuri E, Juvonen T, Vento A, Suojaranta R, Harjula A; AADC consortium. Epicardial delivery of autologous atrial appendage micrografts during coronary artery bypass surgery-safety and feasibility study. Pilot Feasibility Stud. 2017 Dec 20;3:74. doi: 10.1186/s40814-017-0217-9. eCollection 2017. |