title: Post-infarction scar coverage using a pericardial-derived vascular adipose flap. Pre-clinical results.
abstract: BACKGROUND
  Myocardial salvage after coverage with a fat flap was recently demonstrated in acute coronary occlusion. The effect of this novel therapeutic strategy on a chronic myocardial scar is unknown.
  
  
  METHODS
  Myocardial infarction (MI) was induced by coil deployment in the mid circumflex artery in the swine model. Two weeks after infarction, a pericardial-derived adipose flap was transposed, fully covering the scar, in the treated group. Infarct size and histopathology were analyzed on post mortem sections. To assess cell migration, adenoviral eGFP vectors were injected in the adipose flap and expression was evaluated upon sacrifice both at the flap and myocardium. Magnetic resonance imaging (MRI) was used to measure left ventricular (LV) ejection fraction and ventricular volumes at baseline, 2 weeks post-MI, and at 6 weeks.
  
  
  RESULTS
  One month after flap transposition, histopathology confirmed a 34% reduction in infarct size (8.7% vs. 5.7%; P=0.04) and the presence of vascular connections at the flap-myocardium interface. High eGFP expression was detected at the infarct core both at the gene and protein level (negligible signal was detected at the flap on sacrifice). At the functional level, changes in LV ejection fraction and volumes (end-systolic and end-diastolic) were not significantly different between groups (all P values>0.1).
  
  
  CONCLUSIONS
  Our data support the use of post-infarction scar coverage with a pericardial-derived fat flap to reduce infarct size, due partly to neovascular connections and cell trafficking at the flap-myocardium interface. Further studies are needed to validate the functional and clinical relevance of this intervention.
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
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: 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: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000637:transplantation; D000818:Animals; D002921:Cicatrix; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000601:surgery*; D010496:Pericardium / Q000000981:diagnostic imaging* / Q000637:transplantation; D011859:Radiography; D011897:Random Allocation; D013524:Surgical Flaps; D013552:Swine