Ann Thorac Surg 2002;74:974-975
© 2002 The Society of Thoracic Surgeons
Correspondence
Vineberg operation combined with growth factor implantation
Francis Robicsek, MD, PhDa,
Alexander A. Fokin, MD, PhDa
a Department of Thoracic and Cardiovascular Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC 28203, USA
To the Editor
We read with interest the article by Pecher and Schumacher [1] and the correspondence of Johnson and associates [2] and Pecher and Schumacher [3] regarding revival of the Vineberg procedure combined with injection of angiogenic material around the implanted mammary artery. As we [4] suggested in 1999, such an arrangement likely provides a source of collaterals around the implanted mammary graft. Pecher and Schumacher [3] emphasized that the "promising results ... certainly justify increasing efforts in research, and further experimental and clinical investigations" to provide proof of the efficiency of this combined procedure.
This proof has already been obtained. In our canine experiments [5–7], ischemia in the area supplied by the circumflex coronary artery was created by placement of an ameroid. Three weeks later, the left mammary artery was implanted into the ischemic area according to the method of Vineberg. In some of the dogs, basic fibroblast growth factor sustained-release biodegradable pellets (100 µg, the same strength applied by Johnson and colleagues) were inserted into the myocardium around the implantation site. The animals were evaluated 3 weeks after implantation by resting and stress echocardiography, regional myocardial blood flow assessment by colored microspheres, angiography, and capillary staining for factor VIII. We found no differences in ejection fraction, fractional shortening, cardiac output, stroke volume, and regional myocardial blood flow. However, in the group in which the Vineberg operation was combined with growth factor insertion, the return of myocardial contractility and the development of collaterals were significantly better than in dogs that had had only mammary artery implantation (Fig 1).
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Fig 1. Development of collaterals in the two study groups at three different times: baseline (A), 3 weeks after ameroid-induced ischemia (B), and 3 weeks after Vineberg procedure (C). (bFGF = basic fibroblast growth factor.)
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It is our opinion that insertion of growth factors around the implantation site definitely enhances the efficiency of the Vineberg procedure and makes it applicable to patients who, because of the lack of graftable coronary arteries, are not suitable candidates for direct coronary artery bypass grafting.
References
- Pecher P., Schumacher B.A. Angiogenesis in ischemic human myocardium: clinical results after 3 years. Ann Thorac Surg 2000;69:1414-1419.[Abstract/Free Full Text]
- Johnson W.D., Chekanov V.S., Nikolaychik V.V., Kipshidze N. Vineberg procedure combined with therapeutic angiogenesis: old wine in a new bottle. Ann Thorac Surg 2001;72:1443-1444.[Free Full Text]
- Pecher P., Schumacher B.A. Vineberg procedure combined with therapeutic angiogenesis: old wine in a new bottle. Ann Thorac Surg 2001;72:1444.[Free Full Text]
- Robicsek F., Dyke C.M., Fokin A. Angiogenesis: can we combine the very old with the very new?. Ann Thorac Surg 1999;67:1216-1217.[Free Full Text]
- Fokin AA, Robicsek F, Masters TN, Dyke CM, Gordon BE. Vineberg procedure enhanced by growth factor. Proceedings of the 48th Annual Meeting of the Scandinavian Association for Thoracic Surgery, Aalborg, Denmark, August 26–28, 1999. Abstract 57, page 93.
- Fokin A.A., Robicsek F., Masters T.N., Dyke C.M., Gordon B.E. Enhancement of the Vineberg procedure by bFGF application. J Mol Cell Cardiol 2000;32:142.
- Fokin A.A., Robicsek F., Masters T.N., Dyke C.M., Gordon B.E. A Revascularization of ischemic myocardium by bFGF application and Vineberg procedure. Presented at the 6th Annual CTT Meeting 2000, Current Trends in Thoracic Surgery VI, Bal Harbour, FL 2000.
