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local"},"requirement":"routine"},{"purpose":"result_review","after":{"min":90,"max":180,"unit":"days","qualifier":"Echocardiogram or cardiac MRI to review heart function"},"requirement":"routine"}],"indications":["Ischemic cardiomyopathy with reduced ejection fraction","Chronic heart failure after myocardial infarction","Refractory angina without further revascularization options"],"main_risks":["Bleeding at harvest or catheter access sites","Arrhythmia during catheterization or cell delivery","Coronary embolism, perforation or myocardial injury","Infection at harvest or access sites","Allergic or infusion reactions","Contamination of the cell product"],"pain":"Mild to moderate discomfort at the bone marrow or fat harvest site and catheter access site. Usually managed with simple analgesics.","preparation":["Cardiology review and imaging","Blood tests and infection screening","Stop blood thinners as directed","Fast 6-8 hours before procedure","Continue essential heart medications","Review allergies and contrast tolerance"],"recovery_timeline":[{"phase":"Day 0-1","description":"Cell harvest, then processing begins; monitoring for bleeding at the harvest site.","restrictions":["No driving","Avoid heavy exertion"]},{"phase":"Days 2-7","description":"Cell delivery after processing, with monitoring for arrhythmia and bleeding; soreness settles and light daily activity resumes.","restrictions":["Bed rest for several hours after delivery","No heavy lifting","Avoid strenuous exertion"]},{"phase":"Weeks 2-4","description":"Gradual return to normal activity with continued heart medications.","restrictions":["Avoid intense exercise until cleared"]},{"phase":"Months 3-6","description":"Assessment of symptoms and heart function by imaging.","restrictions":[]}],"rehabilitation_days":{"min":2,"max":7,"unit":"days","qualifier":"Ordinary daily activities resume first; depends on baseline heart function and delivery route."},"result_longevity":"Benefit duration not established; reported effects last months to a few years.","revision_rate_pct":null,"scars":"Minimal: tiny puncture marks at the harvest and catheter access sites, usually fading within weeks.","sessions_or_stages":{"sessions":{"min":1,"max":2,"unit":"visits","qualifier":"Usually one delivery; some protocols repeat infusions."},"stages":[{"code":"harvest","label":"Cell harvest (bone marrow or fat)","after":{"min":0,"max":1,"unit":"days","qualifier":"Day 0 of the stay"}},{"code":"processing","label":"Cell processing and preparation","after":{"min":1,"max":5,"unit":"days","qualifier":"Depends on culture or expansion requirement"}},{"code":"delivery","label":"Cell delivery to the heart","after":{"min":2,"max":7,"unit":"days","qualifier":"Typically intracoronary; follows cell processing"}}],"qualifier":"Single trip typical; processing time varies with cell type."},"success":{"metric":"Absolute LVEF improvement on echocardiography or MRI","value":3,"unit":"percentage points","horizon":"6 months","population":"Adults with ischemic cardiomyopathy and reduced ejection fraction","evidence_status":"limited"},"techniques":[{"name":"Intracoronary infusion of bone marrow cells","suits_whom":"Post-infarction ischemic cardiomyopathy with reduced ejection fraction","recovery":"Overnight monitoring; back to light activity in days."},{"name":"Intravenous mesenchymal stem cell infusion","suits_whom":"Chronic heart failure patients wanting a less invasive route","recovery":"Same-day or one night; minimal recovery."},{"name":"Transendocardial intramyocardial injection","suits_whom":"Refractory angina or advanced ischemic heart failure","recovery":"One to two nights; slightly longer arrhythmia monitoring."}],"treatment_conditions":["inpatient","day_case"],"treatment_duration_hours":{"min":2,"max":4,"unit":"hours","qualifier":"Harvest and delivery on the same or separate days; depends on route and cell source."},"initial_assessment_documents":["Recent echocardiogram report","Cardiac MRI report","Coronary angiography report","Discharge summaries of heart attack or surgery","Recent NT-proBNP and blood test results","List of current heart medications"],"travel_trips":{"min":1,"max":3,"one_trip_possible":true,"qualifier":"Usually one trip; harvest to delivery within 2-7 days."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Confirm the surgeon is trained and experienced in the exact procedure you are considering, not just in surgery generally","scope":"treatment_abroad","source":{"url":"https://www.isaps.org/discover/patients-home/considering-your-procedure-abroad/finding-a-surgeon-abroad/","host":"isaps.org","quote":"Verify that the surgeon is trained and experienced 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