Pressure Controlled Vein Graft Flushing Results In Superior Histological Quality - A Randomized Trial
Mani Arsalan, Jörg Kempfert, Sebastian Bader, Alex Meyer, Heike Baumgarten, Sina Schmidt, Johannes Blumenstein, Thomas Walther.
Kerckhoff Clinic, Bad Nauheim, Germany.
OBJECTIVE: The saphenous vein is still one of the most commonly used grafts for coronary artery bypass grafting. Nevertheless several studies show an inferior long term patency compared to arterial grafts.
This could be due to the histologic structure of the vein as it is not intended for a high pressure system.
Another issue might be due to the intraoperative handling of the graft. It could be shown that by flushing the graft during harvesting and preparation accidential peak pressures over 600 mmHg occur inside the vessel. This might lead to endothelial damage of the graft and thus reduce quality and subsequently patency.
Thus, controlling the flushing pressure could prevent endothelial damage. Therefore we investigated whether the usage of a pressure limited syringe influences graft quality and endothelial function.
METHODS: In a randomized trial 50 patients underwent vein harvesting during CABG using a conventional or a pressure limited syringe (Vasoshield, Maquet Cardiovascular LCC, Wayne, USA; limited to 250 mmHg). Vein remnants were examined for endothelial damage and function using CD31 immunostaining and eNOS Western blot analysis.
RESULTS: CD31 immunostaining revealed that endothelial cell integrity in the pressure limited syringe group was 73.2 ± 14.5% of the circumference of luminal endothelium, compared to the conventional syringe group 46.2 ± 21.4% (p<0.05).
ENOS Western blot analyses demonstrated a significantly greater nitric oxidase production in the pressure limited syringe group.
CONCLUSIONS: Our randomized study demonstrates that usage of a pressure limited syringe is capable of reducing histological damages and preserving endothelial function of the saphenous vein graft. Apart from the limited additional costs there seem to be no downsides in using this approach and it might lead to a better vein graft patency.
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