Long-term follow-up of internal mammary artery myocardial implantation

Current state of surgical myocardial revascularization

Despite increasing competition from percutaneous interventions and other novel methods of non-surgical coronary revascularization, coronary artery bypass grafting (CABG) remains one of the most definitive and durable treatments for coronary artery disease, especially for those patients with extensive and diffuse disease. In recent years the CABG procedure itself has undergone innovation and evolution. This review article provides a brief historical perspective on the procedure, and examines the current state of modern variations including off-pump, limited-access, and robotic-assisted CABG.

Vineberg operation: a review of the birth and impact of this surgical technique

The Vineberg operation was introduced by Arthur Vineberg in the early 1940s as an experimental model for revascularization of ischemic cardiac tissue in animal models with direct implantation of left internal mammary artery into ventricular myocardium. The first attempt in a human was performed in 1950, followed by 10,000 to 15,000 Vineberg operations completed in the 1950s and 1960s until the birth of coronary artery bypass grafting. We report a historical perspective, birth and impact of this surgical technique, and possible implications for the future of cardiology and cardiac surgery.

Endogenous myocardial angiogenesis and revascularization using a gastric submucosal patch

BACKGROUND

The gastrointestinal submucosa physiologically produces angiogenic proteins. We examined whether these properties could lead to endogenous myocardial angiogenesis in a swine model of chronic ischemia.

METHODS

Fifteen Yorkshire swine underwent ameroid constrictor placement around the circumflex artery and either lateral epicardial abrasion, creation of a gastroepiploic artery (GEA) based gastric patch, mucosal avulsion, transdiaphragmatic transfer, and apposition of the patch against the circumflex myocardial territory (number = 8; test animals), or lateral epicardial abrasion alone (number = 7; controls). Seven weeks later, lateral myocardial perfusion, endothelial cell density, and expression of VEGFR-1 and VE-cadherin were determined using isotope-labeled microsphere assays, immunohistochemistry, and immunoblotting, respectively.

RESULTS

Microsphere assays showed equivalent lateral/anterior myocardial perfusion indices at rest (1.10 +/- 0.49 vs 0.95 +/- 0.23, test vs control animals; p = 0.54), but higher perfusion in test animals versus controls during pacing (1.05 +/- 0.29 vs 0.69 +/- 0.09, test vs controls; p = 0.02). Increased myocardial endothelial cell density (42.6 +/- 8.5 vs 26.1 +/- 11.6 cells per 3850 microm2, test vs controls; p = 0.02) and expression of VE-cadherin (3.10 +/- 0.60-fold change, test vs controls; p = 0.001) were also observed in the lateral territory of test animals versus controls. Reconstitution of the proximally occluded circumflex artery from patch collaterals was demonstrated on gastroepiploic arteriography in a subset of test animals.

CONCLUSIONS

This model results in an angiogenic process of significantly greater magnitude than that resulting from chronic myocardial ischemia alone, without the need for exogenous angiogenic agents.

Bilateral functioning Vineberg grafts. A 25-year follow-up

This report describes a 25-year follow-up of angiographically proven bilateral functioning Vineberg grafts. This represents the longest angiographic follow-up found in the literature. The relevance of these grafts in present-day revascularization procedures is discussed.

The phantom of "myocardial sinusoids": a historical reappraisal

The concept of myocardial sinusoids has been described in the literature during the past 60 years. They have been the basis of several revascularization procedures, such as the "Vineberg" procedure and more recently transmural laser revascularization. This article will review the historical evolution as well as the validity of the concept of "myocardial sinusoid."

The Vineberg procedure: the immediate forerunner of coronary artery bypass grafting

Promulgated by the Canadian surgeon Arthur Vineberg, internal mammary artery implantation received fairly widespread clinical application during the 1960s, only to be abandoned upon the introduction of coronary artery bypass grafting toward the end of the decade. By 1978, Hurst and Logue's The Heart (4th ed. New York: McGraw-Hill, page 1291) mentioned the procedure only to relate that "indirect myocardial revascularization using the internal thoracic artery is now seldom used." Between the introduction of the operation in 1945 and the mid-1960s, a remarkably hard-fought debate raged over the value of internal mammary artery implantation. Despite the fact that coronary arteriography ultimately demonstrated the viability of Vineberg's concept, for a variety of reasons the operation could not compete with coronary artery bypass grafting, and therefore rapidly fell into disuse. The central role the Vineberg procedure has played in the evolution of coronary revascularization surgery highlights the importance of reviewing the history of its development, application, and eventual abandonment. The Vineberg procedure was, after all, the first intervention documented to increase myocardial perfusion. Recent reports of long-term graft patency and clear patient benefit with internal mammary artery implants reinforce the belief that Vineberg should be given more credit for his work than he has generally received, and that internal mammary artery implantation should not be relegated to the status of a historical curiosity.

Long-term follow-up of the Vineberg internal mammary artery implant procedure

This report describes the 20-year follow-up of a patient who had undergone a double internal mammary implantation for coronary occlusive disease. A lack of similar reports in the literature suggests that such survival is rare, but this case indeed documents the fact that the internal mammary arteries can revascularize the myocardium, and this patient's continued survival appears to depend entirely on this collateral blood flow.

Long-term results of internal mammary artery implantation for coronary artery disease: a controlled trial by the participants of the Veterans Administration Coronary Bypass Surgery Cooperative Study Group

One hundred forty-six adult men from sixteen Veterans Administration hospitals were entered in a controlled prospective clinical trial. Seventy-one patients were randomly allocated to receive implantation of the internal mammary artery into the left ventricular myocardium for chronic ischemic heart disease with angina pectoris, and 75 were assigned to the control group. The two treatment groups were similar at baseline with respect to sixteen clinical and angiographic factors thought to have prognostic importance. Most of the patients were operated on before 1970. Operative mortality was 12%, and implant patency in 52% of eligible patients studied 1 year after operation was 67%. At the end of follow-up extending up to 12 years (mean, 9.3 years), cumulative survival for both groups was similar. Over half of the patients (58%) had died at the end of 10 years (5% per year). While the hypothesis on which the operation was based appears to be valid, the degree of revascularization achievable in most patients did not affect longevity.