Use of Bone Marrow Derived Stem Cell and G-CSF With Circulatory Assistance in the Treatment of DCM

Inclusion Criteria:

• Patients with a confirmed diagnosis of dilated cardiomyopathy under the supervisionof a physician or a heart failure nurse specialist.

• NYHA class ≥ 2 symptoms despite having received optimal medical therapy andappropriate device therapy, as per clinical guidelines for an interval of at least 3months.

• No other treatment options available as part of the current best standard of care.

• LVEF ≤35% on any imaging modality performed as part of the screening phase.

Exclusion Criteria:

• Congenital heart disease.

• Clinically significant valvular heart disease.

• Patients who are not suitable for a Percutaneous Mechanical Support Device (E.g.unsuitable femoral artery anatomy, unable able to lie flat for prolonged time toaccommodate the stem cell infusion & presence of LV thrombus)

• Weight of patient that exceeds the maximum limit of the cardiac catheterisationlaboratory table / CT scanner.

• Cardiomyopathy 2o to a reversible cause that has not been treated e.g. thyroiddisease, alcohol abuse, hypophosphataemia, hypocalcaemia, cocaine abuse, seleniumtoxicity & chronic uncontrolled tachycardia.

• Cardiomyopathy in association with a neuromuscular disorder e.g. Duchenne'sprogressive muscular dystrophy.

• Previous cardiac surgery.

• Contra-indication for bone marrow aspiration (thrombocytopaenia - platelet count <80x 10(9)/L or extensive surgical scarring/anatomical deformity at site of bone marrowpuncture).

• Known active infection on admission as defined by a temperature >37.5°C or on ashort course of antibiotics.

• An active infection of hepatitis B, hepatitis C, syphilis or HTLV

• Known HIV infection

• Chronic inflammatory disease requiring on-going medication.

• Concomitant disease with a life expectancy of less than one year

• Follow-up impossible (no fixed abode, etc.)

• Neoplastic disease without documented remission within the past 5 years.

• Patients on renal replacement therapy.

• Subjects of childbearing potential unless βHCG negative and are on adequatecontraception during the trial.

• Patients falling into the vulnerable category or lacking capacity

• Patients who are unable to understand or read written English will be excluded fromthe trial.

• Killip Class III or above