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In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury
Published on: June 8, 2013
Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct
Carolina Gálvez-Montón1, Cristina Prat-Vidal, Santiago Roura
1ICREC Research Program, IGTP, Cardiology Service, Hospital Universitari Germans Trias i Pujol, Ctra. Can Ruti, Camí de Escoles, s/n, 08916 Badalona, Barcelona, Spain. cgalvezmonton@gmail.com
Insights
A novel pericardial fat flap improves heart function after myocardial infarction by reducing infarct size and preventing adverse ventricular remodeling. This approach shows promise for myocardial salvage and treating heart failure complications.
Area of Science:
- Cardiovascular Surgery
- Regenerative Medicine
- Cardiac Surgery
Background:
- Coronary artery occlusion can lead to ventricular remodeling, heart failure, and cardiogenic shock.
- Effective treatments for these complications are crucial for improving patient outcomes.
- Novel strategies are needed to salvage myocardium after infarction.
Purpose of the Study:
- To investigate the therapeutic potential of a pericardial-derived fat flap in treating acute myocardial infarction.
- To assess the impact of this flap on left ventricular function and remodeling.
- To evaluate the flap's effect on infarct size and myocardial healing.
Main Methods:
- A swine model of coronary artery ligation was used to induce myocardial infarction (n=52).
- A vascularized adipose flap, isolated by pericardium, was transposed to cover the infarcted area.
- Left ventricular function, infarct size, gene expression, and histological changes were assessed using MRI, gene analysis, and postmortem examination.
Main Results:
- Treated animals showed a significant 18.8% increase in left ventricular ejection fraction one month post-intervention.
- Significant reductions in left ventricular end-systolic and end-diastolic volumes were observed in the treated group.
- Histopathology revealed reduced infarct size, vascular connections at the flap-myocardium interface, and decreased apoptosis in the infarct border zone.
Conclusions:
- A vascularized fat flap provides beneficial effects on left ventricular function and limits adverse myocardial remodeling after infarction.
- The flap promotes angiogenesis and cellular proliferation within the flap tissue.
- These findings suggest a potential therapeutic approach for myocardial salvage and treating post-infarction complications.
Aims:
Coronary artery occlusion is associated with the risk of ventricular remodelling, heart failure, and cardiogenic shock. Novel strategies are sought to treat these ominous complications. We examined the effect of a pericardial-derived fat flap secured over an acute infarct caused by coronary occlusion.
Methods And Results:
A novel intervention consisting of the pericardial isolation of a vascularized adipose flap and its transposition fully covering acute infarcted myocardium was developed in the swine model of coronary artery ligation (n= 52). Left ventricular (LV) ejection fraction and LV end-diastolic and end-systolic volumes were assessed using magnetic resonance imaging (MRI). Infarct size and gene expression analysis were performed on Day 6 and 1 month. Histological changes, collagen volume fraction (CVF), and vascular density were also evaluated on postmortem sections. One month after the intervention, a 18.8% increase in LV ejection fraction (P= 0.007), and significant reductions in LV end-systolic (P= 0.009) and LV end-diastolic volumes (P= 0.03) were found in treated animals compared with the control-MI group. At Day 6, histopathology confirmed a significant infarct size reduction (P= 0.018), the presence of vascular connections at the flap-myocardium interface, and less apoptosis in the infarct border zone compared with control animals (P< 0.001). Up-regulation of genes involved in cell cycle progression, cellular growth and proliferation, and angiogenesis were identified within the flap.
Conclusions:
Our results indicate that a vascular fat flap exerts beneficial effects on LV function and limits myocardial remodelling. Future studies must confirm whether these findings provide an alternative therapeutic approach for myocardial salvage after infarction.
