Cardiolaser will protect against the development of a heart attack
Laser and stem cells give the heart a second life
Anna Govorova, Infox.ru
Cardiac surgeons from the Bakulev Center for Cardiovascular Surgery have begun to perform unique operations: with the help of a laser and stem cells, they save the lives of patients with severe coronary heart disease (CHD) when neither stenting nor coronary artery bypass grafting helps, reports Infox. The vessels in this case are very thin and branched so much that it is simply impossible to restore blood flow through them using traditional surgical methods.
"Today, coronary heart disease, which can lead to the development of myocardial infarction, is treated very well by two methods. In case of acute occurrence of a single-vascular lesion, a stent is placed. As a result, blood flow is restored. And a person generally forgets that he had any health problems. If the patient has a multivessel lesion and several other indications, then coronary artery bypass grafting is performed. But in a fairly large group of patients (25-30% in total), when the vessels are so severely affected, neither stenting nor coronary artery bypass grafting can be performed. Already 20 years ago, we began to think about how we could help such patients," says Leo Bokeria.
Scientists know an amazing fact: a number of mammals do not have a system of coronary vessels, and blood enters the heart muscle directly from the left ventricle. It turns out that the left ventricle contracts, supplying blood to the aorta and to those openings that are distributed throughout the myocardium.
"We decided to take this principle as a basis. Then the idea arose to make through tubules through the heart," says Leo Bokeria.
For these purposes, a high–power Cardiolaser device was created around 1997 - and this is a completely Russian development. The second similar device, but with slightly different characteristics, is made only in the USA. By the way, the Russian device is more powerful and accurate.
"Since 1997, "Cardiolaser" has been used in our center. When we summed up the results, it turned out that after 10 years, approximately 94% of our patients are alive and feeling well. And at the same time, we began to use stem cells, injected them through an artery. More than 1000 patients have been treated with stem cells to date. And then the idea came up to combine these two methods. A hypothesis of laser and stem cell synergy has emerged," says Leo Bokeria.
Now this is no longer an abstract hypothesis, but a real clinical practice.
The patient lying on the operating table is 65 years old. He suffers from such a severe form of coronary heart disease that he could hardly move: every few meters he had an attack of angina pectoris, and he suffered a heart attack. The heart tissue is almost completely covered with scars, but live cardiomyocytes (heart muscle cells still, fortunately, remained). The patient is operated by the director of the Scientific Center for Cardiovascular Surgery named after A.N. Bakulev, a leading Russian cardiac surgeon, academician Leo Bokeria.
"The ejection fraction of our patient is 45-50%. In this case, the operation is well tolerated. Now, if it were smaller, then our method would not work here," says Leo Bokeria.
The operation takes place on an open working heart. The "cardiolaser" is synchronized with the patient's electrocardiogram, and in the diastole state (when the heart is resting), through holes are made in the heart.
Mesenchymal stem cells taken from the patient's own bone marrow are then injected into these areas just a few hours before surgery. Mesenchymal stem cells have an unlimited possibility of transformation into different types of cells and tissues, and after a certain time, once in the right place, they turn into vascular endothelium.
"We are launching the process of formation of new vessels – neoangiogenesis. At the first stage, stem cells activate the processes of neoangiogenesis, and the laser itself causes specific inflammation, which contributes to this. As a result, a new myocardial nutrition network is being formed," says Leo Bokeria.
The operation is very complicated, but it does not last long. "I am sure that everything will be fine for our patient," says Leo Bokeria.
He has five more surgeries scheduled for that day.
"In our center, the first operation begins at 6 o'clock in the morning. Yes, no, I'm not tired at all. There are many issues that the medical community is not able to solve. But where we can help, we are ready to work for days," says Bokeria.
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09.12.2016