Papakonstantinou Nikolaos A, Sykaras Alexandros G, Vourlakou Christina, Goudevenos John, Papadopoulos Georgios, Apostolakis Efstratios
Cardiothoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece.
Cardiothoracic Surgery Department, School of Medicine, University Hospital of Ioannina, Greece.
J Card Surg. 2020 May;35(5):996-1003. doi: 10.1111/jocs.14519. Epub 2020 Mar 24.
Despite their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits to achieve complete revascularization during coronary artery bypass grafting (CABG). Although vein storage critically impairs endothelial integrity, contradictory data concerning optimal storage solutions exist. The aim of this study is to explore any in vitro impact of cardioplegic solutions and temperature on vein grafts endothelial integrity during their storage.
A single-center, prospective trial including 40 consecutive patients was conducted. Eligibility criteria included patients submitted to CABG receiving at least one vein graft. An excess segment of the graft was harvested and divided into four different parts. Each one of them was stored under different conditions; either in a conventional heparin-enriched blood solution or in a cardioplegic solution, at room temperature (20°C-22°C) and in the refrigerator (5°C). Endothelial integrity was evaluated via immunohistochemistry using an antibody against CD31.
Endothelial integrity (measured in a scale from 1-worst to 5-best) was significantly better after cardioplegic solution storage (2.83 ± 0.15 and 3.10 ± 0.13 in cold and room temperature, respectively) compared with storage in conventional solutions (2.23 ± 0.16 and 2.0 ± 0.15 in cold and room temperature, respectively). A significant effect of cardioplegic storage solution, as well as of cold temperature and cardioplegic solution interaction on endothelial preservation was reported, whereas storage temperature did not prove a significant factor by its own.
Cardioplegic storage solutions result in significantly better endothelial preservation compared with conventional heparin-enriched blood solutions. The association with superior clinical outcomes remains to be proved.
尽管大隐静脉移植物的长期通畅率不尽人意，但在冠状动脉旁路移植术（CABG）中，它是实现完全血运重建最广泛使用的血管 conduit。虽然静脉储存严重损害内皮完整性，但关于最佳储存溶液的数据相互矛盾。本研究的目的是探讨心脏停搏液和温度对静脉移植物储存期间内皮完整性的体外影响。
进行了一项单中心前瞻性试验，纳入40例连续患者。纳入标准包括接受CABG且至少接受一个静脉移植物的患者。采集移植物的多余节段并分成四个不同部分。每个部分在不同条件下储存；要么在传统的富含肝素的血液溶液中，要么在心脏停搏液中，分别在室温（20°C - 22°C）和冰箱（5°C）中。通过使用抗CD31抗体的免疫组织化学评估内皮完整性。
与在传统溶液中储存相比（分别在低温和室温下为2.23±0.16和2.0±0.15），心脏停搏液储存后内皮完整性（从1 - 最差到5 - 最佳评分）明显更好（分别在低温和室温下为2.83±0.15和3.10±0.13）。报告了心脏停搏储存溶液以及低温和心脏停搏溶液相互作用对内皮保存有显著影响，而储存温度本身并未被证明是一个显著因素。
与传统的富含肝素的血液溶液相比，心脏停搏储存溶液能显著更好地保存内皮。与更好的临床结果之间的关联仍有待证明。
