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

Wilbring, Manuel; Tugtekin, Sems Malte; Zatschler, Birgit; Ebner, Anette; Reichenspurner, Hermann; Matschke, Klaus; Deußen, Andreas

doi:10.1016/j.ejcts.2011.01.024

Cited by 45 publications

(76 citation statements)

References 15 publications

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“…19, 20 GALA, as the most widely recognized of these solutions, was used for physiologic characterization along with more traditional solutions. GALA contains glutathione and L-ascorbic acid, antioxidants, and arginine, a substrate for nitric oxide synthase in endothelial cells, which were added to a buffered electrolyte solution.…”

Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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Introduction Recent clinical data suggests intraoperative preservation of human saphenous vein (HSV) in normal saline is associated with vein graft failure. We evaluated the influence of several preservation media on acute physiologic function and cellular viability of HSV conduit. Methods Unprepared (UP) HSV obtained from coronary artery bypass graft patients was characterized on a muscle bath after two hour storage in Plasma-Lyte A, normal saline, University of Wisconsin solution, Celsior solution, autologous whole blood, or glutathione-ascorbic acid- L-arginine (GALA) solution. Vascular smooth muscle contractility to depolarizing KCl and phenylephrine was assessed. The relaxation of phenylephrine-pre-contracted HSV to sodium nitroprusside and carbachol (endothelial-independent and -dependent relaxation, respectively) was also assessed. Cellular viability was determined via the methyl thiazolyl tetrazolium (MTT) assay. Rat aortae were used to assess the effect of pH during graft preservation on endothelial-dependent relaxation. Results Preservation of HSV in normal saline and autologous whole blood impaired contractile responses to KCl relative to UP tissues, while University of Wisconsin solution and Celsior solution preservation enhanced contractile responses (P<.05). Relative to UP tissues, responses to phenylephrine were decreased with preservation in normal saline, while preservation in University of Wisconsin solution, Celsior solution and GALA all potentiated these responses (P<.05). Only normal saline preservation impaired endothelial-independent relaxation (P=.005). Preservation in Plasma-Lyte A (P=.02), normal saline (P=.002) and University of Wisconsin solution (P=.02) led to impaired endothelial-dependent relaxation. Normal saline preservation led to a decreased MTT viability index relative to UP tissues (0.021±0.002 mg−10.5 mL−1 vs. 0.033±0.005 mg−10.5 mL−1; P=.03). Endothelial function was impaired by acidic pH in rat aorta. Conclusions Normal saline preservation causes graft injury leading to impaired physiologic function and decreased viability of HSV. This harm to the conduit is mitigated by the use of buffered salt solutions as preservation media.

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Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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“…3 In the regular course of bypass graft surgery, vein and artery grafts are stored at room temperature for Ͻ2 hours. 4 However, it could be reasonable to keep vessel segments of patients with a desperate graft situation for later reimplantation should early graft failure occur. Here, cold storage is advised.…”

mentioning

confidence: 99%

Functional, morphologic, and molecular characterization of cold storage injury

Ebner

Poitz

Augstein

et al. 2012

Journal of Vascular Surgery

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“…Although the mechanisms of VGF are not completely understood, endothelial damage during vein graft harvesting and implantation is known to be an important cause of acute and intermediate VGF. 8,9 Although significant attention has been given to various harvesting techniques to minimize trauma, 10 intraoperative graft preservation solutions have not been investigated in recent clinical studies. The lack of evidence is illustrated by a lack of consensus and variation in the use of vein graft preservation solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Although Gundry et al 12 showed that storage in a saline solution had deleterious effects on endothelial function compared with preservation in autologous blood, other studies 13-18 aiming to substantiate these findings have shown conflicting results. Other studies 9,15,16,19-23 have investigated the effect of storage in various buffered saline solutions on vessel wall tension and endothelial function in discarded vein graft segments and overall have shown improved endothelial function after preservation in a buffered saline storage solution compared with saline- and/or blood-based media.…”

Section: Discussionmentioning

confidence: 99%

Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

et al. 2014

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IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions.

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

Abstract: Even short-time storage in PSS significantly impairs endothelial vascular function. Concerning the essential role of a faultless endothelial layer, the quite common use of PSS as a storage solution for SVSs in CABG surgery has to be discussed critically.

Cited by 45 publications

References 15 publications

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Functional, morphologic, and molecular characterization of cold storage injury

Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

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