Objective: Ischemic heart disease accounts for 50% of all cardiovascular deaths and is the leading cause of congestive heart failure. Medical therapy, cardiac assist devices and surgical procedures including heart transplantation have limited efficiency and availability. Stem cell transplantation represents a new therapeutic opportunity for such patients. Method: Six patients with the diagnosis of ischemic cardiomyopathy were included in this study. All of the patients had clinical, radiological and echocardiographic signs of heart failure, and reduced left ventricular ejection fraction (LVEF less than or equal to25%). They underwent coronary angiography and stress tests with dobutamine echocardiography, thallium scintigraphy and positron emission tomography to assess myocardial ischemia and viability. Peripheral stem cells were mobilized and collected by apheresis. They were transplanted into areas of injury with open-heart surgery. To increase blood flow to the engrafted areas, coronary artery by-pass surgery was also performed. Results: The patients were followed at least for 4 months. Echocardiography, thallium scintigraphy and positron emission tomography were repeated after at least 6 weeks following surgery. There was a significant increase in life quality and NYHA class. Some benefit was documented on echocardiography, thallium scintigraphy, and positron emission tomography. Conclusion: This approach opens a new window in the treatment of 'no hope' patients with congestive heart failure. (C) 2003 Elsevier B.V. All rights reserved.