Improved Preservation of Saphenous Vein Grafts by the Use of Glyceryl Trinitrate–Verapamil Solution During Harvesting

Roubos, Nick; Rosenfeldt, Franklin; Richards, Stephen M.; Conyers, R. A. J.; Davis, Bruce

doi:10.1161/01.cir.92.9.31

Cited by 84 publications

(55 citation statements)

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“…Surgical distension of SV with heparinized blood or saline is performed during surgery to check for leakage from side branches, and distension pressures of Ͼ450 mm Hg have been observed. 22 This type of distension has been shown to cause morphological and biochemical alterations in the vessel wall. 23,24 In addition, several hemodynamic changes occur in the SV after implantation into the coronary circulation, including alterations in blood flow, transmural pressure, shear stress, and radial stress.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical Stretch Induces Phosphorylation of p38-MAPK and Apoptosis in Human Saphenous Vein

Cornelissen

Armstrong

Holt

2004

ATVB

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Objective-Failure of saphenous vein grafts remains a major limitation of coronary bypass surgery. The aims of the present study were to determine whether pressure distension of human saphenous vein induces the activation of p38-MAPK and to determine its role in apoptosis. Methods and Results-Phosphorylated p38 was detected at basal levels in human saphenous vein obtained immediately after harvesting. Distended saphenous vein showed significantly higher levels of phosphorylated p38 compared with control vein (PϽ0.01) and nondistended saphenous vein maintained for 3 and 6 hours after harvesting (both PϽ0.01 A utologous saphenous vein (SV) is the commonest conduit used for peripheral and coronary artery bypass grafting. However, 30% to 50% of vein grafts become occluded by 10 years. 1 The causes of vein graft occlusion are thrombosis in the early stages, and later the proliferation and migration of intimal smooth muscle cells along with the deposition of extracellular matrix leading to myointimal hyperplasia. 1 The precise cellular mechanisms involved in these processes remain unclear; however, surgical trauma to the vessel, including the stretch that occurs during manual distension before implantation, as well as implantation of the vein into the arterial circulation may be important.Apoptosis is reported to occur in pathological SV grafts, where it is thought to be involved in the transformation of a smooth muscle cell-rich myointimal thickening toward a fibrous cell-poor intimal thickening. 2,3 Apoptosis has also been shown to occur in tissue remodeling, associated with longitudinal stretch (axial strain) in rabbit carotid arteries. 4 We have previously shown that apoptosis is induced in pressure-distended human SV and is associated with increased vessel wall expression of the transcription factor c-fos, a downstream component of various signaling cascades. 5 In cultured porcine vascular smooth muscle cells (VSMCs), cyclic stretch has been shown to cause an increase in apoptosis, accompanied by a sustained activation of the mitogen-activated protein kinases (MAPK) JNK and p38. 6 In vitro studies using cultured smooth muscle cells have shown that mechanical stretch can activate ras/rac/p38 signal pathways 7 and p38 phosphorylates p53, which is responsible for mechanical stress-induced apoptosis. 8 In addition, the application of biomechanical stress has been shown to increase apoptosis in mouse vein grafts, and this occurs via p38 activation. 9 MAPKs are proline-directed serine/threonine kinases activated by dual phosphorylation on threonine and tyrosine residues in response to a wide variety of extracellular stimuli. The JNK and p38 MAPK signaling cascades are activated in response to cellular stress and certain cytokines via the activation of G protein coupled receptors 10 and are known to be involved in apoptosis. 11 Overexpression of MAPKs upstream of p38, such as MKK-3, leads to sustained activation of p38 and apoptosis. 12,13 However, ERK-MAPK is downregulated during apoptosis and upregulated during cellula...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mechanical Stretch Induces Phosphorylation of p38-MAPK and Apoptosis in Human Saphenous Vein

Cornelissen

Armstrong

Holt

2004

ATVB

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“…Even when conducted under optimized conditions, harvesting of SV grafts causes extensive endothelial disruption; indeed, more than 50% of the endothelial layer is denuded after preparation. 7 Loss of the endothelium activates coagulation via the exposure of tissue factor (TF), a key protease activator forming a catalytic complex with factor VIIa and thereby initiating coagulation, on vascular smooth muscle cells (VSMCs). 8 The important role of TF in the hemostatic activation phase early after bypass surgery is underscored by the observation that expression of TF is enhanced after coronary artery bypass grafting irrespective of whether an on-pump or off-pump procedure was performed.…”

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confidence: 99%

Prothrombotic Gene Expression Profile in Vascular Smooth Muscle Cells of Human Saphenous Vein, but Not Internal Mammary Artery

Payeli

Latini

Gebhard

et al. 2008

ATVB

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Background— The resistance of internal mammary artery (IMA) toward thrombotic occlusion and accelerated atherosclerosis is not well understood. This study analyzed gene expression profiles of vascular smooth muscle cells (VSMCs) from IMA versus saphenous vein (SV). Methods and Results— 54′675 probe sets were examined by Affymetrix microarrays. Thirty-one genes belonged to the coagulation system; 2 were differentially expressed, namely tissue factor (TF) and tissue-type plasminogen activator (tPA). TF was 3.1-fold lower in IMA than SV ( P =0.006), whereas tPA was 9.0-fold higher ( P <0.001). TF mRNA expression was lower in IMA than SV ( P <0.05); tPA was higher ( P <0.001). TF protein expression was 4.2±0.5-fold lower in IMA than SV ( P <0.001); tPA was 2.6±0.4-fold higher ( P <0.01). In IMA VSMC supernatant, TF protein and activity was lower ( P <0.05), TFPI and tPA protein higher ( P <0.05 and P <0.005), and clotting time of human plasma prolonged ( P <0.05) as compared to SV. Migration to TF/FVIIa (10 −9 mol/L) was 3-fold lower in IMA than SV ( P =0.01); PAR-2 protein expression was similar ( P =NS), PAR-2 blockade without effect ( P =NS). Conclusions— Among the genes of the coagulation system, TF and tPA are differentially expressed in VSMCs from IMA versus SV. This is consistent with protection of IMA from thrombus formation and vascular remodeling.

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“…We did not perform this type of analysis but based our assessment only on the incidence of trans-operative infarction and mortality; several factors are involved with this variable, such as the anastomosis technique, the distal coronary bed, the method of myocardial protection and the ventricular function. However, it is incontestable that a badly preserved or injured graft during resection is associated with a higher incidence of occlusion [11]. In this series we had one death in each group.…”

Section: Commentsmentioning

confidence: 90%

Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio

Martins¹,

Andrade²,

Silva³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To comparatively analyze minimally invasive procurement of saphenous veins using the MINI-HARVEST ® system and a technique using adapted traditional instruments.Method: From June 1996 to January 1999, 63 patients who were submitted to coronary artery bypass grafting surgery had their saphenous veins resected using minimally invasive techniques. For the first 30 patients of the series, a direct visualization method employing two Langenbeck's retractors was utilized and for the remaining 33 patients the MINI-HARVEST ® technique was used.Results: The mean age of the patients was 61 ± 8.75 years old. Fifty-two patients were male and 11 female. Forty-five patients were diabetics, 45 were either overweight or obese, 25 were smokers and 32 presented histories of myocardial infarction. The mean time to resect the saphenous vein using the Langenbeck's retractors was 34.2 ± 8.14 minutes and using the MINI-HARVEST ® system it was 39.20 ± 9.12 minutes. The lengths of the extracted veins were similar in both groups, varying between 10 and 30 cm. There was one case of superficial dehiscence in the Langenbeck group. With two patients in the MINI-HARVEST ® group and one in the Langenbeck group it was necessary to revert to the traditional method of procurement. The incidence of trans-operative infarction was 4.5 % (three patients) in the Langenbeck group and 3.1% (two patients) in the MINI-HARVEST ® group.Conclusions: We can conclude that the minimally invasive procurement methods of the saphenous vein by direct visualization are effective and safe, both when employing with adapted traditional instruments and when using purposemade retractors. We stress, however, that the MINI-HARVEST ® method does not require an assistant.

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Improved Preservation of Saphenous Vein Grafts by the Use of Glyceryl Trinitrate–Verapamil Solution During Harvesting

Cited by 84 publications

References 19 publications

Mechanical Stretch Induces Phosphorylation of p38-MAPK and Apoptosis in Human Saphenous Vein

Mechanical Stretch Induces Phosphorylation of p38-MAPK and Apoptosis in Human Saphenous Vein

Prothrombotic Gene Expression Profile in Vascular Smooth Muscle Cells of Human Saphenous Vein, but Not Internal Mammary Artery

Obtenção minimamente invasiva de veia safena para cirurgia de revascularização do miocárdio

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