Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):690-6. doi: 10.1016/j.jtcvs.2012.01.017. Epub 2012 Feb 4.
We evaluated the efficacy of minimally manipulative surgical strategies to harvest the saphenous vein for use in a Y-composite graft based on the left internal thoracic artery in terms of preservation of endothelial structure and function.
Twenty patients who underwent off-pump coronary revascularization using the saphenous vein in a Y-composite graft based on the left internal thoracic artery were studied. The saphenous vein was harvested from each patient with minimal manipulation. An excess saphenous vein segment was removed before dilatation (control group), and a second segment was removed after dilation performed using a pressure-sensing syringe (conventional group). A third segment was obtained from a Y-composite vein graft dilated by flow and pressure from the left internal thoracic artery (composite group). Hematoxylin-eosin staining and immunohistochemistry using antibodies against CD31, CD34, von Willebrand factor, and endothelial nitric oxide synthase were performed. A generalized estimating equation was adopted for statistical analysis.
Histologic and immunohistochemical studies revealed better endothelial preservation in the composite and control groups than in the conventional group (P < .01 in each). The composite group saphenous vein showed a lower grade of endothelial integrity than the control group saphenous vein based on hematoxylin-eosin staining, CD34 immunohistochemistry, and nitric oxide synthase staining (P < .001 in each).
Harvesting of the saphenous vein using minimal manipulation for use in a Y-composite graft based on the left internal thoracic artery preserved endothelial structure and function when compared with manually dilated saphenous vein harvesting.
我们评估了微创外科策略从左内乳动脉 Y 型复合移植物中获取大隐静脉的功效,主要是从内皮结构和功能的角度来评估。
我们研究了 20 例在非体外循环下使用左内乳动脉 Y 型复合移植物中的大隐静脉进行冠状动脉血运重建的患者。每位患者的大隐静脉均采用微创方法获取。在扩张前(对照组)切除一段多余的大隐静脉,在使用压力感应注射器扩张后(常规组)切除第二段。从左内乳动脉血流和压力扩张的 Y 型复合静脉移植物中获取第三段(复合组)。进行苏木精-伊红染色和 CD31、CD34、血管性血友病因子和内皮型一氧化氮合酶抗体的免疫组化染色。采用广义估计方程进行统计分析。
组织学和免疫组化研究显示,复合组和对照组的内皮保存情况优于常规组(P<0.01)。与对照组大隐静脉相比,复合组大隐静脉的苏木精-伊红染色、CD34 免疫组化和一氧化氮合酶染色显示出较低的内皮完整性等级(P<0.001)。
与手动扩张大隐静脉相比,使用微创方法从左内乳动脉 Y 型复合移植物中获取大隐静脉可以更好地保存内皮结构和功能。