Surgical Treatment of Cardiac Ischmæmia

O'Shaughnessy, Laurence

doi:10.1016/s0140-6736(00)97446-4

Cited by 98 publications

(31 citation statements)

References 10 publications

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“…O uso do grande epíploon em mediastinite foi inicialmente proposto por LEE et al (36) , em 1976, baseando-se em reconstruções da parede torácica descritas por KIRICUTA (40) , em 1963, e em antigas revascularizações miocárdicas (41) .…”

Section: Comentáriosunclassified

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Sampaio¹,

Alves²,

Silva³

et al. 2000

Rev Bras Cir Cardiovasc

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A cirurgia cardíaca não foge à regra. Apesar de ser sofisticado método de tratamento invasivo, observamos a ocorrência de quadros infecciosos gravíssimos que desafiam a competência da equipe cirúrgica e dos centros de tratamento cardiológico.A abertura do esterno para possibilitar o acesso ao coração, introduzida por MILTON (1,2) , em 1897, e popularizada por JULIAN (3) et al., tem sido evitada sempre que possível. Lança-se mão de procedimentos cardiológicos invasivos com cateteres ou balões (4) e, ultimamente, de abordagens cirúrgicas através de reduzidas incisões torácicas com ou sem o auxílio de videotoracoscopia (5)(6)(7)(8)(9)(10)(11) , com excelentes resultados.A incidência de mediastinite nos procedimentos operatórios cardíacos em que se pratica esternotomia é pequena, variando de 0,4 a 5% (12,13) . A mortalidade desta temível complicação, no entanto, é alta, variando de 14 a 47% (14) . Além desta alta mortalidade, verifica-se considerável aumento dos custos do tratamento após esta complicação, quase triplicando estes valores (15,16) .Os fatores de risco parecem ser muitos, podendo ser citados: associação de diabete melito e

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Section: Comentáriosunclassified

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Sampaio¹,

Alves²,

Silva³

et al. 2000

Rev Bras Cir Cardiovasc

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“…The omentum has been historically used in surgical revascularization for patients with ischemic heart disease [14][15][16] and is also known to have rich vasculature and angiogenic factors. 17,18 Importantly, we reported that a pedicle omentum flap covering the transplanted skeletal myoblast cell sheets enhanced angiogenesis over the cell-sheet-transplanted territory, survival of cells, and therapeutic effects.…”

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confidence: 99%

Enhanced Survival of Transplanted Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes by the Combination of Cell Sheets With the Pedicled Omental Flap Technique in a Porcine Heart

et al. 2013

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Background— Transplantation of cardiomyocytes that are derived from human induced pluripotent stem cell–derived cardiomyocytes (hiPS-CMs) shows promise in generating new functional myocardium in situ, whereas the survival and functionality of the transplanted cells are critical in considering this therapeutic impact. Cell-sheet method has been used to transplant many functional cells; however, potential ischemia might limit cell survival. The omentum, which is known to have rich vasculature, is expected to be a source of blood supply. We hypothesized that transplantation of hiPS-CM cell sheets combined with an omentum flap may deliver a large number of functional hiPS-CMs with enhanced blood supply. Methods and Results— Retrovirally established human iPS cells were treated with Wnt signaling molecules to induce cardiomyogenic differentiation, followed by superparamagnetic iron oxide labeling. Cell sheets were created from the magnetically labeled hiPS-CMs using temperature-responsive dishes and transplanted to porcine hearts with or without the omentum flap (n=8 each). Two months after transplantation, the survival of superparamagnetic iron oxide–labeled hiPS-CMs, assessed by MRI, was significantly greater in mini-pigs with the omentum than in those without it; histologically, vascular density in the transplanted area was significantly greater in mini-pigs with the omentum than in those without it. The transplanted tissues contained abundant cardiac troponin T–positive cells surrounded by vascular-rich structures. Conclusions— The omentum flap enhanced the survival of hiPS-CMs after transplantation via increased angiogenesis, suggesting that this strategy is useful in clinical settings. The combination of hiPS-CMs and the omentum flap may be a promising technique for the development of tissue-engineered vascular-rich new myocardium in vivo.

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“…11 While cardiac tissue-engineered approaches to repair the ischemic myocardium offer improved donor cell retention compared to intramyocardial cell injections, a drawback faced by cardiac patches aiming at postischemic myocardial repair is limited donor cell survival resulting from poor vascularization within thick constructs. Omental wrapping or omentopexy, a classical technique introduced in the mid1930s to treat myocardial ischemia by promoting revascularization from a pedicle with omental vessels to coronary arteries, 12 has recently been reintroduced in the cardiac tissue engineering setting to promote neovascularization in myocardial grafts. Omentopexy has been used to cover various types of cardiac patches in situ, including scaffolds seeded with MSC in a rat model, 13 and a fibroblast growth factor (FGF)-hydrogel sheet covering the area of myocardial ischemia in rabbits.…”

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confidence: 99%

Cord Lining-Mesenchymal Stem Cells Graft Supplemented with an Omental Flap Induces Myocardial Revascularization and Ameliorates Cardiac Dysfunction in a Rat Model of Chronic Ischemic Heart Failure

Lilyanna

Martinez

et al. 2013

Tissue Engineering Part A

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Myocardial restoration using tissue-engineered grafts to regenerate the ischemic myocardium offers improved donor cell retention, yet a limited cell survival resulting from poor vascularization needs to be addressed. A cell type derived from the subamnion, namely, cord-lining mesenchymal stem cells (CL-MSC), has recently been identified. Here we present a restorative strategy that combines a fibrin graft containing human CL-MSC and omental flap providing, thereby, cell-, structural-, and angiogenic support to the injured myocardium. The graft consisted of a mixture of 2 · 10 6 CL-MSC-GFP-Fluc and fibrin. Myocardial infarction (MI) was induced in nude rats and following confirmation of ensued heart failure with echocardiography 2 weeks after injury, therapeutic intervention was performed as follows: untreated (MI, n = 7), CL-MSC graft (CL-MSCG, n = 8), CL-MSCG and omental flap (CL-MSCG + OM, n = 11), and omental flap (OM, n = 8). In vivo bioluminescence imaging at 1, 3, 7, and 14 days post-treatment indicated comparable early donor cell viability between the CL-MSCG and CL-MSCG + OM. Treatment with CL-MSCG + OM improved the myocardial function as assessed by the measurement of end-diastolic left ventricular (LV) pressure (3.53 -0.34 vs. 5.21 -0.54 mmHg, p < 0.05), contractility ( + dP/dt, 3383.8 -250.78 mmHg vs. 2464.9 -191.8 mmHg, p < 0.05), and the relaxation rate (-dP/ dt, -2707.2 -250.7 mmHg vs. 1948.7 -207.8 mmHg, p < 0.05), compared to MI control 6 weeks after ischemic injury. Furthermore, evidence of a 20.32% increase in the ejection fraction was observed in CL-MSCG + OM rats from week 2 to 6 after injury. Both CL-MSCG and CL-MSCG + OM led to an enhanced cardiac output (p < 0.05), and attenuated the infarct size (35.7% -4.2% and 34.7% -4.8%), as compared to MI (60.7% -3.1%; p < 0.01 and p < 0.001, respectively). All treated groups had a higher arteriole density than controls. Yet, a higher amount of functional blood vessels, and a 20-fold increase in arteriole numbers were found in CL-MSCG + OM. Altogether, CL-MSCGs supplemented with vascular supply have the potential to repair the failing, chronically ischemic heart by improving myocardial revascularization, attenuating remodeling, and ameliorating cardiac dysfunction.

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Surgical Treatment of Cardiac Ischmæmia

Cited by 98 publications

References 10 publications

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Mediastinite em cirurgia cardíaca: tratamento com epíploon

Enhanced Survival of Transplanted Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes by the Combination of Cell Sheets With the Pedicled Omental Flap Technique in a Porcine Heart

Cord Lining-Mesenchymal Stem Cells Graft Supplemented with an Omental Flap Induces Myocardial Revascularization and Ameliorates Cardiac Dysfunction in a Rat Model of Chronic Ischemic Heart Failure

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