Cardiac Lymphatic Modulation in Myocardial Repair: From Lymphangiogenesis to Microsurgical Reconstructive Strategies

The cardiac lymphatic system is increasingly recognized as a regulator of myocardial fluid homeostasis and tissue remodeling following myocardial injury. Experimental evidence suggests that impaired lymphatic drainage contributes to persistent edema, chronic inflammation and functional deterioration after myocardial infarction and other acute and chronic cardiovascular conditions. However, the translational relevance of pharmacological and microsurgical reconstructive strategies remains largely unexplored. A literature review was performed using PubMed/MEDLINE to identify studies addressing the anatomy, physiology, pathophysiology, and potential therapeutic strategies addressing the cardiac lymphatic system. This study finds that cardiac lymphatics drain myocardial interstitial fluid and immune cells toward mediastinal pathways. Across various disease models, cardiac lymphatic dysfunction contributes to prolonged edema, inflammation, and adverse fibrotic remodeling. In preclinical models, pro-lymphangiogenic strategies have increased lymphatic growth and transport and have been associated with more favorable remodeling. By contrast, lymphovenous anastomosis and vascularized lymph node transfer remain largely untested concepts in cardiac disease; their ability to improve myocardial lymphatic drainage or clinical outcomes has not been demonstrated. Consequently, cardiac lymphatics may become an important therapeutic target in myocardial repair. Preliminary evidence supports the pharmacological promotion of lymphangiogenesis as a promising strategy for myocardial regeneration, but further research is necessary to explore the safety, feasibility and effectiveness of surgical cardiac lymphatic modulation.