<i>In vitro</i> comparison of glyceryl trinitrate‐verapamil with other dilators of human saphenous vein

Jesuthasan, Lalith S.B.; Angus, James A.; Rosenfeldt, Franklin

doi:10.1046/j.1445-2197.2003.t01-1-02613.x

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…However, efforts to mitigate the effect of the learning curve would become an important public health issue if the results of our pilot study are ultimately confirmed. Prior studies have suggested that as few as 20 cases of experience are required to complete the learning curve of EVH [16]. In contrast, we found that learning was not complete with even close to 100 cases of experience when using conduit injury on OCT imaging as a more a sensitive metric for learning.…”

Section: Commentcontrasting

confidence: 62%

“…Division of branches was performed with bipolar electrocautery set at 20 W. Proximal saphenous vein ligation was performed through a separate stab incision. After removal from the leg, the saphenous vein was flushed and stored in a Plasma-Lyte solution (Baxter International, Inc, Deerfield, IL) containing heparin, glyceryl trinitrate, and verapamil [16]. After grafting, blood flow was measured in each SVG using transit time ultrasound (Medistim, Inc, Oslo, Norway).…”

Section: Methodsmentioning

confidence: 99%

“…Endoscopic vein harvest inherently requires forces to be applied to the vein that are usually avoided in open harvest, including traction, adventitial stripping, and venous compression. Despite obvious differences in vein handling compared with open methods, multiple prior comparisons of techniques have failed to demonstrate measurable differences in endothelial integrity or other markers of conduit integrity [16, 22, 23]. However, these investigations of conduit quality have been limited to discarded specimens of the vein with the assumption that intimal loss observed histochemically from these graft segments closely reflects the overall status of the endothelium within the graft proper.…”

Section: Commentmentioning

confidence: 99%

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Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency

Desai

Kiani

Thiruvanthan

et al. 2011

The Annals of Thoracic Surgery

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Background Recent studies have suggested that endoscopic vein harvest (EVH) compromises graft patency. To test whether the learning curve for EVH alters conduit integrity owing to increased trauma compared with an open harvest, we analyzed the quality and early patency of conduits procured by technicians with varying EVH experience. Methods During coronary artery bypass grafting, veins were harvested open (n = 10) or by EVH (n = 85) performed by experienced (>900 cases, >30/month) versus novice <100 cases, <3/month) technicians. Harvested conduits were imaged intraoperatively using optical coherence tomography and on day 5 to assess graft patency using computed tomographic angiography. Results Conduits from experienced (n = 55) versus novice (n = 30) harvesters had similar lengths (33 versus 34 cm) and harvest times (32.4 versus 31.8 minutes). Conduit injury was noted in both EVH groups with similar distribution among disruption of the adventitia (62%), intimal tears at branch points (23%), and intimal or medial dissections (15%), but the incidence of these injuries was less with experienced harvesters and rare in veins procured with an open technique. Overall, the rate of graft attrition was similar between the two EVH groups (6.45% versus 4.34% of grafts; p = 0.552). However, vein grafts with at least 4 intimal or medial dissections showed significantly worse patency (67% versus 96% patency; p = 0.05). Conclusions High-resolution imaging confirmed that technicians inexperienced with EVH are more likely to cause intimal and deep vessel injury to the saphenous vein graft, which increases graft failure risk. Endoscopic vein harvest remains the most common technique for conduit harvest, making efforts to better monitor the learning curve an important public health issue.

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Section: Commentcontrasting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency

Desai

Kiani

Thiruvanthan

et al. 2011

The Annals of Thoracic Surgery

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“…Nicorandil relaxed the contraction of the HIMA, HSV, and radial artery induced by phenylephrine, KCl, and the TxA 2 analogue U46619. 18,[20][21][22] In the present study, phenylephrine, an a 1 -adrenoceptor agonist, was used to contract the HSV and HIMA. Phenylephrine is a potent vasoconstrictor that can contract arterial and vein grafts even when endothelium is intact.…”

Section: Discussionmentioning

confidence: 99%

Different K+ Channels Are Involved in Relaxation of Arterial and Venous Graft Induced by Nicorandil

Novakovic

Pavlović

Stojanović

et al. 2011

Journal of Cardiovascular Pharmacology

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The drug nicorandil is a vasodilator approved for the treatment of angina. In addition to its well-known effect on the opening of ATP-sensitive K (KATP) channels, nicorandil-induced vasorelaxation also involves the opening of Ca-activated K channels. The aim of this study was to investigate the effects of nicorandil on the isolated human internal mammary artery (HIMA) and the human saphenous vein (HSV) and to define the contribution of different K channel subtypes in the nicorandil action on these arterial and venous grafts. Our results show that nicorandil induced a concentration-dependent relaxation of HSV and HIMA rings precontracted by phenylephrine. Glibenclamide, a selective KATP channels inhibitor, partially inhibited the response to nicorandil in both HSV and HIMA. Iberiotoxin, a most selective blocker of large-conductance Ca-activated K (BKCa) channels, partly antagonized relaxation of HIMA. A nonselective blocker of voltage-gated K channels, 4-aminopyridine caused partial inhibition of the nicorandil-induced relaxation of HSV but did not antagonize relaxation of HIMA induced by nicorandil. Margatoxin, a potent inhibitor of KV1.3 channels, did not abolish the effect of nicorandil on HSV and HIMA. Our results showed that nicorandil induced strong endothelium-independent relaxation of HSV and HIMA contracted by phenylephrine. It seems that KATP and 4-aminopyridine-sensitive K channels located in the smooth muscle of HSV mediated relaxation induced by nicorandil. In addition, KATP and BKCa channels are probably involved in the nicorandil action on HIMA.

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“…Procured SVGs and RA grafts were initially flushed with heparinized saline by using syringe injection, with no methods used to control the distending pressure (54%), to prepare the conduits for grafting. The remainder of the conduits were flushed in a plasmalyte solution containing glyceryl trinitrate and verapamil 11 using controlled distending pressure at less than 100 mm Hg. The proximal aortic anastomoses were performed first for each SVG or RA graft with a partial occluding aortic clamp.…”

Section: Surgical Techniquementioning

confidence: 99%

Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery

Burris

Schwartz

Tang

et al. 2007

The Journal of Thoracic and Cardiovascular Surgery

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In vitro comparison of glyceryl trinitrate‐verapamil with other dilators of human saphenous vein

Abstract: The present paper demonstrates the following conclusions: (i) glyceryl trinitrate is a rapidly acting dilator of the human isolated SV. (ii) GTN-V combination is a potent combination causing a maximum dilator effect that is significantly greater than single agents including SNP and N.

Cited by 5 publications

References 21 publications

Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency

Impact of the Learning Curve for Endoscopic Vein Harvest on Conduit Quality and Early Graft Patency

Different K+ Channels Are Involved in Relaxation of Arterial and Venous Graft Induced by Nicorandil

Catheter-based infrared light scanner as a tool to assess conduit quality in coronary artery bypass surgery

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