Stem Cells and Myocardial Regeneration: Open-ChestiMinimally Invasive Surgical Techniques.

Chronic heart failure has emerged as a major worldwide epidemico Recently, a fundamental hift in the underlying etiology of chronic heart failure is becoming evident, in which the most ommon cause is no longer hypertension or valvular disease, but rather long-term survival after acute myocardial infarction (MI). The costs of this syndrome, both in economie and personal terms, are considerable. American Heart Association statistics indicate that chronic heart failure affects 4.7 million patients in the United States and is responsible for approx l million hospitalizations and 300,000 deaths annually. The societal impact of chronic heart failure is also remarkable. Patients with chronic heart failure often suffer a greatly compromised quality of life. About 30% of diagnosed individuals (i.e., 1.5 million in the United States) experience difficulty breathing with little or no physical exertion and are very restricted in their daily functions. This forced sedentary lifestyle inevitably leads to further physical and mental distress. However, it is evident, running through the different therapeutic strategies of chronic heart failure, that the appropriate treatment of patients with ischemic heart failure is stilI unknown. Since 1992, a revolutionary option to treat cardiac disease has come to the scene based on the possibility of using autologous cells, appropriately cultured and expanded, to replace or provide new contractile tissue as well as new sources of blood perfusion. Celi transplantation is currently generating a great deal of interest in that the replacement of akinetic scar tissue by viable myocardium should improve cardiac function, impede progressive left ventricular remodeling, and revascularize the ischemic area. From the originai paper of Marelli and colleagues in 1992, presenting for the first time the concept of using autologous skeletal muscle cells to repair a damaged zone of the heart, a procedure termed "cellular cardiomyoplasty," supportive experimental as well as clinical evidence has been published in respect to the potential of celi transplantation for cardiac repair or regeneration. A variety of cell populations have been applied for cardiac repair either experimentally or c1inically. Each celi type has its own profile of advantages, limitations, and practicability issues, particularly in the clinical setting. Several options are under evaluation in terms of mode of delivery. In this chapter we will discuss the fundamentals of the direct epicardial approach in celi transplantation using either an open- or closed-chest (endoscopy) technique.