Department for Cardiac Surgery, University Heart Center Dresden, Dresden, Germany.
Eur J Cardiothorac Surg. 2011 Oct;40(4):811-5. doi: 10.1016/j.ejcts.2011.01.024. Epub 2011 Mar 3.
A faultless endothelial layer is decisive for vascular function and therewith graft's patency. Functional impairment of the endothelium increases risk of graft thrombosis, intimal hyperplasia, and consecutive accelerated graft atherosclerosis. Storage solutions for intra-operatively harvested saphenous vein segments (SVS) might have significant impact on endothelial function. We investigated the impact of short-time storage in physiological saline solution (PSS) and a potassium-chloride- and N-acetylhistidine-enriched storage solution on venous endothelial function.
Intra-operatively isolated SVSs (n=19) were stored in different storage solutions for 90 min. They were then immediately studied in tissue bath at 36°C with continuous oxygen insufflation. Following preconstriction with norepinephrine, dose-response relaxation curves of bradykinine (Brad) and sodium nitroprusside (SNP) were determined. We compared developed maximum wall tension, vessel constriction kinetics, endothelial cell- and smooth muscle cell (SMC)-dependent vasodilatory function.
Maximum vessel wall tension was reduced significantly in PSS-stored vessels (10.1 ± 9.8 mN mm(-1) vs 3.5 ± 3.4 mN mm(-1); p=0.0372). Endothelium-derived vasodilatory function was likewise significantly reduced after short-time storage (20.6 ± 34.4% vs 35.0 ± 27.0%; p=0.0437). SNP-mediated SMC-vasodilatory function was maintained equally well in both groups (88.2 ± 21.8% vs 83.0 ± 30.6% in PSS; p=n.s.).
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.
完美的内皮细胞层对于血管功能和移植物通畅性至关重要。内皮功能障碍会增加移植物血栓形成、内膜增生和随后加速的移植物动脉粥样硬化的风险。术中采集的大隐静脉段(SVS)的储存液可能对内皮功能有重要影响。我们研究了在生理盐溶液(PSS)和富含钾、氯和 N-乙酰组氨酸的储存液中短时间储存对静脉内皮功能的影响。
术中分离的 SVS(n=19)分别储存在不同的储存液中 90 分钟。然后,在 36°C 的组织浴中,在持续氧气充气下立即进行研究。用去甲肾上腺素预收缩后,测定缓激肽(Brad)和硝普钠(SNP)的剂量反应性舒张曲线。我们比较了最大壁张力、血管收缩动力学、内皮细胞和平滑肌细胞(SMC)依赖性血管舒张功能。
PSS 储存的血管最大壁张力显著降低(10.1±9.8 mN/mm(-1) 与 3.5±3.4 mN/mm(-1);p=0.0372)。短时间储存后,内皮衍生的血管舒张功能也显著降低(20.6±34.4% 与 35.0±27.0%;p=0.0437)。两组 SNP 介导的 SMC 血管舒张功能均保持良好(PSS 中分别为 88.2±21.8% 和 83.0±30.6%;p=n.s.)。
即使在 PSS 中短时间储存也会显著损害内皮血管功能。鉴于完美的内皮层的重要作用,必须对 CABG 手术中作为 SVS 储存液的相当常见的 PSS 的使用进行批判性讨论。