Study of the intraoperative endothelial injury of implanted vein grafts during coronary artery bypass grafting and correlation with intraoperative protective measures (Doctoral thesis)

Παπακωνσταντίνου, Νικόλαος Α.

Coronary artery disease is the leading cause of death worldwide. Coronary artery bypass grafting remains the treatment of choice in myocardial revascularization against multi-vessel coronary artery and left main disease. Although their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits during coronary artery bypass grafting. Consequently, vein graft failure remains a major problem. As a result, strategies improving long-term vein graft patency are imperative. Multiple factors, including graft storage solution from the time of harvesting to the time of graft implantation, influence endothelial integrity and subsequently long-term graft patency. Therefore, it is imperative to ideally store the unaffected by the harvesting procedure parts of the endothelium to avoid further endothelial deterioration. However, there are contradictory data about the optimal storage solution. The addition of potassium in the storage solution seems to be protective for the saphenous vein graft endothelium. MATERIAL & METHODS A single centre, prospective trial including 40 consecutive patients was conducted. Eligibility criteria included all patients submitted to coronary artery bypass grafting with at least one planned vein graft no matter their comorbidities, the extent of their coronary artery disease, their sex, age or any other factors. An excess of the vein graft was harvested and divided into four different parts stored to different conditions; in conventional heparin-enriched blood saline solution or in a cardioplegic solution, in room temperature (20-22°C) and in the refrigerator (5°C). The endothelium integrity was evaluated via light microscopy and immunohistochemistry using an antibody against CD31. RESULTS Our comparative analysis revealed a significant effect of vein storage solution on the integrity of vein endothelium, F(2.798, 109.1)=22.46, p<0.0001. Cardioplegic solutions are significantly better for the preservation of the endothelial integrity of the vein samples, whereas storage temperature does not seem to be a significant factor. CONCLUSIONS Storage solutions have a critical role in the preservation of the vein graft endothelial structural and functional integrity. An intact endothelium is of paramount importance for graft patency. However, physiologic saline solution, although most widely used as a storage solution, impairs vascular and endothelial function even after short-time storage. On the contrary, cardioplegic solutions result in significantly better endothelial preservation. The association with superior clinical outcomes remains to be proved.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Αορτοστεφανιαία παράκαμψη
Keywords: Μόσχευμα σαφηνούς φλέβας,διαλύματα συντήρησης,καρδιοπληγικό διάλυμα,αορτοστεφανιαία παράκαμψη,αστοχία φλεβικού μοσχεύματος,λειτουργικότητα ενδοθηλίου,saphenous vein graft (SVG),storage solutions,cardioplegic solution,coronary artery bypass grafting (CABG),vein graft failure (VGF),endothelial vascular function
Appears in Collections:Διδακτορικές Διατριβές

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