Duman Ipek, Tanyeli Ömer, Dereli Yuksel, Oltulu Pembe, Toy Hatice, Sahin Ayse Saide
Department of Medical Pharmacology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Department of Cardiovascular Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Arch Med Sci. 2021 Mar 24;18(6):1607-1616. doi: 10.5114/aoms/110157. eCollection 2022.
Autologous saphenous vein (SV) and internal mammary artery (IMA) are used as bypass conduits during coronary artery bypass graft surgery. Vasospasm of the arterial and venous grafts may constitute a significant clinical problem. Pretreatment with a vasodilator drug of the graft or intraluminal injection before implantation may be used for spasm prophylaxis. This study was designed to assess the vasoactive effects and time-dependent changes of botulinum toxin A (BTX-A) and papaverine pretreatment on vasospasm of human SV and IMA grafts. Also, histomorphology of the vessels was assessed.
SV and IMA segments were suspended in organ baths, and isometric contraction responses to 2 different concentrations of 5-hydroxytryptamine (5-HT) and endothelin-1 (ET-1) were recorded after incubation with 2 different concentrations of BTX-A and papaverine at 2 time points (0 h and 2 h).
The results revealed the following: 1) incubation with BTX-A and papaverine relaxes both SV and IMA rings contracted with 5-HT and ET-1; 2) the duration of the relaxant effect of BTX-A lasts longer than papaverine; and 3) no apparent histomorphological changes were observed in the grafts under light microscopy.
This study demonstrates that in human SV and IMA grafts, pretreatment with both BTX-A and papaverine are safe and have a potent inhibitory effect depending on the vessel and vasoconstrictor agent. The long-lasting vasodilatory effect of BTX-A on vascular smooth muscle may provide promising results in the prevention of venous and arterial graft spasm.
在冠状动脉旁路移植手术中，自体大隐静脉（SV）和乳内动脉（IMA）被用作旁路血管。动脉和静脉移植物的血管痉挛可能构成一个重大的临床问题。移植物的血管扩张药物预处理或植入前腔内注射可用于预防痉挛。本研究旨在评估A型肉毒杆菌毒素（BTX-A）和罂粟碱预处理对人SV和IMA移植物血管痉挛的血管活性作用和时间依赖性变化。此外，还评估了血管的组织形态学。
将SV和IMA节段悬挂于器官浴槽中，在2个时间点（0小时和2小时）用2种不同浓度的BTX-A和罂粟碱孵育后，记录对2种不同浓度的5-羟色胺（5-HT）和内皮素-1（ET-1）的等长收缩反应。
结果显示如下：1）用BTX-A和罂粟碱孵育可使被5-HT和ET-1收缩的SV和IMA环松弛；2）BTX-A的松弛作用持续时间比罂粟碱长；3）在光学显微镜下，移植物未观察到明显的组织形态学变化。
本研究表明，在人SV和IMA移植物中，BTX-A和罂粟碱预处理都是安全的，并且根据血管和血管收缩剂的不同具有有效的抑制作用。BTX-A对血管平滑肌的持久血管舒张作用可能为预防静脉和动脉移植物痉挛提供有希望的结果。
