Damage to Arterial and Venous Endothelial Cells in Bypass Grafts Induced by Several Solutions Used in Bypass Surgery

Abstract

The purpose of our study was to evaluate the cytotoxicity of incubation solutions used in heart surgery to endothelial cells. The endothelial layer of human saphenous veins (HSV) and bovine internal mammary arteries (BMA) and veins (BMV) were studied after a two-hour storage interval and compared with control vessel segments prepared immediately after harvesting. To visualize the endothelial cell damage, specimens were stained with a silver nitrate technique. The surface covered by light-microscopically intact endothelial cells was computed in percent. In the control HSV segments 70.8 +/- 4.6% of the endothelium were found to be morphologically intact. The results for stored HSV segments were 50.0 +/- 4.2% (Bretschneider's solution), 14.8 +/- 4.5% (physiological saline), 0.45 +/- 0.1% (physiological saline with heparin), 16.7 +/- 4.7% (Ringer's lactate) and 37.2 +/- 5.3% (heparinized blood). Comparable values obtained with BMA specimens were 98.3 +/- 0.7% (controls), 78.1 +/- 4.7% (Bretschneider's solution), 39.2 +/- 3.3% (physiological saline), 8.4 +/- 2.0% (physiological saline with heparin), 11.3 +/- 1.7% (Ringer's lactate) and 67.8 +/- 6.2% (heparinized blood). A similar trend was found with BMV segments: 85.2 +/- 4.7% (controls), 75.6 +/- 6.0% (Bretschneider's solution), 49.5 +/- 8.9% (physiological saline), 5.95 +/- 0.7% (physiological saline with heparin), 6.2 +/- 0.7% (Ringer's lactate) and 54.3 +/- 5.1% (heparinized blood). In conclusion, Bretschneider's solution proved to be superior for storage of bypass grafts in comparison to all other tested solutions in this series.

Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts

“…Of particular interest is the faultlessness of the graft's endothelial layer. Endothelial injury promotes leukocyte and thrombocyte adhesion with consecutive inflammatory reactions and is causal in development of graft atherosclerosis [16]. In this regard, an optimized intra-operative storage of the graft between the time point of explantation and reimplantation is of particular interest [16].…”

“…Endothelial injury promotes leukocyte and thrombocyte adhesion with consecutive inflammatory reactions and is causal in development of graft atherosclerosis [16]. In this regard, an optimized intra-operative storage of the graft between the time point of explantation and reimplantation is of particular interest [16]. Frequently used options are HTK solution, Ringer's lactate solution, PSS, or blood augmented with heparin [16].…”

“…Most important aspects include the method of preparation -conventional, bridging, or endoscopic techniques -to name at least some of them [3], the impact of hydrostatic pressure during intra-operative distensions, and the intra-operative graft storage between harvesting and implantation. Basic considerations are to optimize the graft before implantation and to inhibit activation of the endothelial layer [4,5]. Endothelial activation and injury of the endothelial layer promote leukocyte and platelet adhesion.…”

Effect of Troglitazone on expression of adhesion molecules and eNOS in human saphenous vein gaft

“…Leucocytes adhering to endothelium initiate the restenosis of graft vein, which was regulated by adhesion molecules. Expression of VCAM-1, ICAM-1 and P-selectin in HSV significantly increased during harvesting and preserving process leading to proinflammatory status [1,7] . NF-κB, STAT and AP-1 are important transcript factors in signal pathway which regulate inflammatory response.…”

Addition of vardenafil into storage solution protects the endothelium in a hypoxia- reoxygenation model

“…solutions for storing saphenous vein grafts, 3,4 the poor longterm preservation capacity of HTK solution has been demonstrated by an in vitro coronary artery model. 5 However, saline or HTK solutions are spread in clinical routine.…”