Vineberg procedure and cardiomyoplasty Can the Vineberg procedure improve blood supply to the latissimus dorsi muscle during cardiomyoplasty?

To evaluate the feasibility of implanting the internal mammary artery (IMA) in the latissimus dorsi muscle (LDM) during cardiomyoplasty to create a bipediculated muscle flap. Four dogs went under cardiomyoplasty with the right LDM. The IMA was dissected with the intercostal arteries branching from the IMA clipped except for the three most distal branches. The distal part of the IMA was tunneled in the LDM from ventral to dorsal and left to bleed in the muscle flap. The muscle flap was gradually stimulated to achieve stimulation every 10 heart beats in 10 days. Three months after surgery the dogs were evaluated with echocardiography and a selective angiogram of the IMA. Immunohistochemistry was performed to evaluate the density of capillaries in the LDM. One dog died one week after the surgery due to thrombus in the iliac bifurcation. Three months after surgery, the IMA was patent in the remaining three dogs. Angiogram showed multiple collaterals from the IMA perfusing into the middle segment of the LDM in each dog. Immunohistochemistry showed that the density of capillary followed a gradient from distal to proximal in the LDM (p=0.1). Three months after surgery, stimulated beats had an aortic velocity increased by 19.2% and a left ventricular end systolic volume reduced by 36% when compared to non assisted beats. The IMA transposed in the LDM stimulated for cardiomyoplasty remained patent for three months. Multiple collaterals developed from the IMA seem to contribute to LDM perfusion.