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Intrapericardial procedures for cardiac regeneration by stem cells

Need for minimal invasive access (AttachLifter) to the normal pericardial cavity

Intraperikardiale Verfahren zur kardialen Regeneration durch Stammzellen

Notwendigkeit eines minimal-invasiven Zugangs (AttachLifter) in den normalen Herzbeutel

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Abstract

In view of the only modest functional and anatomical improvements achieved by bone marrow-derived cell transplantation in patients with heart disease, the question was addressed whether the intracoronary, transcoronary–venous, and intramyocardial delivery routes are adequate. It is hypothesized that an intrapericardial delivery of stem cells or activators of resident cardiac stem cells increases therapeutic benefits. From such an intrapericardial depot, cells or modulating factors, such as thymosin β4 or Ac-SDKP, are expected to reach the myocardium with sustained kinetics. Novel tools which provide access to the pericardial space even in the absence of pericardial effusion are, therefore, described. When the pericardium becomes attached to the suction head (monitored by an increase in negative pressure), the pericardium is lifted from the epicardium (“AttachLifter”). The opening of the suction head (“Attacher”) is narrowed by flexible clamps which grab the tissue and improve the vacuum seal in the case of uneven tissue. A ridge, i.e.,“needle guidance”, on the suction head excludes injury to the epicardium, whereby the pericardium is punctured by a needle which resides outside the suction head. A fiberscope can be used to inspect the pericardium prior to puncture. Based on these procedures, the role of the pericardial space and the presence of pericardial effusion in cardiac regeneration can be assessed.

Zusammenfassung

Angesichts der nur moderaten funktionellen und anatomischen Verbesserungen durch eine Stammzelltransplantation bei Herzerkrankungen stellt sich die Frage, ob die intrakoronaren, transkoronar-venösen und intramyokardialen Applikationswege ausreichen. Wir postulieren, dass eine intraperikardiale Applikation von Stammzellen bzw. Aktivatoren der residenten kardialen Stammzellen den therapeutischen Nutzen erhöht. Aus dem intraperikardialen Depot erreichen Zellen bzw. modulierende Faktoren (z. B. Thymosin β4, AC-SDKP) das Myokard in einer protrahierten Kinetik. Daher werden neue Instrumente beschrieben, die den Zugang in den Herzbeutel auch in Abwesenheit eines Perikardergusses ermöglichen. Das Perikard wird an den Ansaugkopf eines solchen Instruments (AttachLifter) angeheftet, die Anheftung wird überwacht durch einen Anstieg des Unterdrucks. Dabei wird Perikard vom Epikard angehoben („Lifter“), die Öffnung des Ansaugkopfes („Attacher“) wird durch flexible Klemmen eingeengt, die das Gewebe festhalten und einen Vakuumverlust bei unebenem Gewebe verhindern. Eine geeignete Nadelführung am Ansaugkopf verhindert eine Verletzung des Epikards während der Perikardpunktion (Nadel befindet sich außerhalb des Ansaugkopfes). Zur Beurteilung der Perikardoberfläche kann vor der Punktion eine Fiberglasoptik (Perikardioskop) eingesetzt werden. Basierend auf diesen Verfahren kann die Beschaffenheit des Perikards mit oder ohne Perikarderguss bei der kardialen Regeneration bewertet werden.

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Acknowledgments

The study was supported by the Marburg Cardiac Promotion Society.

Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine – Cardiology, Experimental Cardiology Laboratory, Philipps University of Marburg, Karl-von-Frisch-Str. 1, 35032, Marburg, Deutschland

    H. Rupp Ph.D., T.P. Rupp & N. Jung

  2. Department of Surgery, Hospital of Aschaffenburg, Aschaffenburg, Deutschland

    T.P. Rupp

  3. Department of Internal Medicine – Cardiology, UKGM GmbH, Marburg, Deutschland

    P. Alter, S. Pankuweit & B. Maisch

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  1. H. Rupp Ph.D.
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  2. T.P. Rupp
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  3. P. Alter
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  4. N. Jung
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  5. S. Pankuweit
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  6. B. Maisch
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Correspondence to H. Rupp Ph.D..

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Rupp, H., Rupp, T., Alter, P. et al. Intrapericardial procedures for cardiac regeneration by stem cells. Herz 35, 458–466 (2010). https://doi.org/10.1007/s00059-010-3382-7

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