title: Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: ICREC 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
authors.forename: Carolina
authors.initials: C
authors.lastname: Gálvez-Montón
authors.forename: Cristina
authors.initials: C
authors.lastname: Prat-Vidal
authors.forename: Santiago
authors.initials: S
authors.lastname: Roura
authors.forename: Jordi
authors.initials: J
authors.lastname: Farré
authors.forename: Carolina
authors.initials: C
authors.lastname: Soler-Botija
authors.forename: Aida
authors.initials: A
authors.lastname: Llucià-Valldeperas
authors.forename: Idoia
authors.initials: I
authors.lastname: Díaz-Güemes
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Arís
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000818:Animals; D003094:Collagen / Q000032:analysis; D054059:Coronary Occlusion / Q000150:complications; D005260:Female; D005786:Gene Expression Regulation; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D010496:Pericardium; D013318:Stroke Volume; D013524:Surgical Flaps; D013552:Swine; D016277:Ventricular Function, Left
chemical_list: D003094:Collagen