Culclasure Talley F, Tran Tien-Ahn, Kameh Darian, Hartz Whitney, Herrera Peter, Lyle Holly
Department of Internal Medicine, School of Medicine, Mercer University, Macon, GA, USA.
JSLS. 2012 Jan-Mar;16(1):16-22. doi: 10.4293/108680812X13291597715745.
Endoscopic vessel harvesting (EVH) traditionally uses carbon dioxide (CO(2)) gas for insufflation. The CO(2) based on government regulations is bone dry and room temperature. All previous EVH studies use this type of unconditioned gas. It is hypothesized that by changing the quality of CO(2) gas differences may occur that are attributable to dry gas versus wet gas exposure.
A comparison of the effect(s) of traditional dry CO(2) gas compared to humidified exposure was done using a porcine model and evaluated in a double-blind randomized controlled fashion.
Vessels exposed to traditional dry cold gas had morphologic and structural changes noted on histologic evaluation. This included desiccation changes of the tunica adventitia desiccation and tunica media collagen and elastin. Vessels exposed to dry gas showed 10% to 12% contraction and constriction with tortuous changes to the intima and endothelial lining that were progressive with increasing volumes of gas exposure. No desiccation or morphologic changes were seen with humidified warmed gas produced using the VesselGuardian.
Traditional dry cold CO(2) caused vascular tissue damage extending from the adventitia to intima, changing the vessel in morphologic and structural configuration. With the VesselGuardian humidified warmed, gas maintained vessel morphology and integrity by preventing desiccation. Changing the quality of CO(2) from dry and cold to wet and warm may offer clinical utility for a better quality conduit for coronary artery bypass graft procedures.
传统的内镜下血管获取（EVH）使用二氧化碳（CO₂）气体进行气腹。基于政府规定的二氧化碳是干燥且处于室温的。以往所有的EVH研究都使用这种未经处理的气体。据推测，通过改变二氧化碳气体的质量，可能会出现因干燥气体与湿润气体暴露而导致的差异。
使用猪模型对传统干燥二氧化碳气体与湿润暴露的效果进行比较，并以双盲随机对照方式进行评估。
组织学评估显示，暴露于传统干燥冷气体的血管有形态和结构变化。这包括外膜干燥、中膜胶原蛋白和弹性蛋白的干燥变化。暴露于干燥气体的血管出现10%至12%的收缩和狭窄，内膜和内皮衬里有扭曲变化，且随着气体暴露量增加而逐渐加重。使用VesselGuardian产生的湿润温热气体未观察到干燥或形态变化。
传统的干燥冷二氧化碳会导致从外膜到内膜的血管组织损伤，改变血管的形态和结构。使用VesselGuardian湿润温热气体可通过防止干燥来维持血管形态和完整性。将二氧化碳的质量从干燥寒冷变为湿润温暖可能对冠状动脉旁路移植手术中获得质量更好的管道具有临床应用价值。
