冠状动脉旁路移植术前大隐静脉移植物保存的微环境

Microenvironment of saphenous vein graft preservation prior to coronary artery bypass grafting.

作者信息

Chen Shao-Wei, Chu Yen, Wu Victor Chien-Chia, Tsai Feng-Chun, Nan Yu-Yun, Lee Hsin-Fu, Chang Chih-Hsiang, Chu Pao-Hsien, Wu Semon, Lin Pyng-Jing

机构信息

Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan.

Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Interact Cardiovasc Thorac Surg. 2019 Jan 1;28(1):71-78. doi: 10.1093/icvts/ivy201.

DOI:10.1093/icvts/ivy201

PMID:29986023

Abstract

OBJECTIVES

The best preservation solution for a free vascular graft prior to coronary artery bypass grafting (CABG) remains controversial. The aim of this investigation was to evaluate the microenvironment of the human saphenous vein graft when preserved in normal saline (NS) solution or autologous heparinized whole blood (AWB).

METHODS

Between January 2014 and December 2014, 21 patients who underwent CABG were enrolled and a total of 162 saphenous vein graft rings were collected. NS and AWB were used to investigate the influence of the microenvironment. The hypoxia, oxidative stress and vascular apoptosis were assayed by western blot, and endothelial integrity was assessed by immunohistochemical analysis.

RESULTS

The level of PaO2 in AWB was lower than that in NS (median: 100.5 mmHg vs 185.8 mmHg, P = 0.004). This hypoxic condition led to the production of more hypoxia-inducible factor-1 (median: 60.1% vs 15.1%, P = 0.008) and endothelial nitric oxide synthase (median: 52.6% vs 25%, P = 0.046) within 30 min of preservation time. The fact that higher levels of glutathione peroxidase resulted in the preservation of AWB suggests that it is beneficial to boost the vascular antioxidant defense with lower levels of NOX2. AWB led to increased Bcl-2, reduced cytochrome c and cleaved 85 kDa poly ADP-ribose polymerase apoptotic fragments.

CONCLUSIONS

We concluded that AWB possesses a microenvironment that is superior to that of NS for saphenous vein graft preservation prior to CABG.

摘要

目的

冠状动脉旁路移植术（CABG）前用于游离血管移植物的最佳保存溶液仍存在争议。本研究的目的是评估人隐静脉移植物在生理盐水（NS）溶液或自体肝素化全血（AWB）中保存时的微环境。

方法

2014年1月至2014年12月，纳入21例行CABG的患者，共收集162个隐静脉移植物环。使用NS和AWB来研究微环境的影响。通过蛋白质印迹法检测缺氧、氧化应激和血管凋亡情况，并通过免疫组织化学分析评估内皮完整性。

结果

AWB中的PaO2水平低于NS中的水平（中位数：100.5 mmHg对185.8 mmHg，P = 0.004）。这种低氧状态导致在保存30分钟内产生更多的缺氧诱导因子-1（中位数：60.1%对15.1%，P = 0.008）和内皮型一氧化氮合酶（中位数：52.6%对25%，P = 0.046）。较高水平的谷胱甘肽过氧化物酶导致AWB保存良好，这表明降低NOX2水平对增强血管抗氧化防御有益。AWB导致Bcl-2增加、细胞色素c减少以及85 kDa多聚ADP-核糖聚合酶凋亡片段裂解。