BACKGROUND: Severe ischemic heart failure with left ventricular ejection fraction (LVEF 35%) ≤ remains a major therapeutic challenge despite optimal medical therapy and surgical revascularization. Coronary artery bypass grafting (CABG) alone may not fully restore infarcted myocardium. Autologous CD133⁺ bone marrow stem cell (BMSC) therapy has been proposed as a regenerative adjunct to enhance myocardial recovery. We report the long-term clinical and functional outcome of a patient with advanced ischemic cardiomyopathy treated with combined CABG and CD133⁺ BMSC implantation.

CASE REPORT: A 69-year-old man with multivessel coronary artery disease and severely reduced LVEF (20.4%) presented with New York Heart Association (NYHA) class III symptoms. He underwent CABG combined with intraoperative transepicardial and transseptal injection of autologous CD133 ⁺ BMSC without perioperative complications. At 6 months, functional capacity improved (6-minute walk distance from 240 m to 446 m), and NYHA class improved to I. At 2-year follow￾up, further structural and functional improvement was observed, including increased LVEF of up to (63%), reduced ventricular volumes, decreased scar size, and improved wall motion score index. Peripheral blood microRNA profiling showed dynamic changes during follow-up.

CONCLUSIONS: This single-patient case describes a favorable long-term clinical and structural trajectory after combined CABG and autologous CD133 stem cell therapy in severe ischemic heart failure. ⁺ However, as an uncontrolled case observation, causality cannot be inferred, and the relative contributions of CABG, CD133 cell implantation, and patient-specific recovery remain ⁺ uncertain. These findings should be interpreted as observational and hypothesis-generating.

Keywords: Coronary Artery Bypass, Bone Marrow Cells, regenerative medicine, Ventricular Dysfunction