Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK.
Department of Cardiac Surgery, Imperial College London, London SW7 2BX, UK.
Cells. 2023 Mar 6;12(5):815. doi: 10.3390/cells12050815.
The long saphenous vein is the most used conduit in cardiac surgery, but its long-term patency is limited by vein graft disease (VGD). Endothelial dysfunction is a key driver of VGD; its aetiology is multi-factorial. However emerging evidence identifies vein conduit harvest technique and preservation fluids as causal in their onset and propagation. This study aims to comprehensively review published data on the relationship between preservation solutions, endothelial cell integrity and function, and VGD in human saphenous veins harvested for CABG. The review was registered with PROSPERO (CRD42022358828). Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE databases were undertaken from inception until August 2022. Papers were evaluated in line with registered inclusion and exclusion criteria. Searches identified 13 prospective, controlled studies for inclusion in the analysis. All studies used saline as a control solution. Intervention solutions included heparinised whole blood and saline, DuraGraft, TiProtec, EuroCollins, University of Wisconsin (UoW), buffered, cardioplegic and Pyruvate solutions. Most studies demonstrated that normal saline appears to have negative effects on venous endothelium and the most effective preservation solutions identified in this review were TiProtec and DuraGraft. The most used preservation solutions in the UK are heparinised saline or autologous whole blood. There is substantial heterogeneity both in practice and reporting of trials evaluating vein graft preservation solutions, and the quality of existing evidence is low. There is an unmet need for high quality trials evaluating the potential for these interventions to improve long-term patency in venous bypass grafts.
大隐静脉是心脏外科最常用的移植物，但由于静脉移植物疾病（VGD）其长期通畅性受到限制。内皮功能障碍是 VGD 的关键驱动因素；其病因是多因素的。然而，新出现的证据表明，静脉移植物采集技术和保存液是其发病和传播的原因。本研究旨在全面回顾已发表的关于保存液、内皮细胞完整性和功能与用于 CABG 的大隐静脉采集的 VGD 之间关系的研究数据。综述已在 PROSPERO（CRD42022358828）上注册。从成立到 2022 年 8 月，对 Cochrane 中央对照试验注册库、MEDLINE 和 EMBASE 数据库进行了电子检索。根据已注册的纳入和排除标准评估论文。检索确定了 13 项前瞻性、对照研究纳入分析。所有研究均使用生理盐水作为对照溶液。干预溶液包括肝素化全血和生理盐水、DuraGraft、TiProtec、EuroCollins、威斯康星大学（UoW）、缓冲液、心脏停搏液和丙酮酸溶液。大多数研究表明，生理盐水似乎对静脉内皮有负面影响，本综述中确定的最有效的保存溶液是 TiProtec 和 DuraGraft。在英国，最常用的保存溶液是肝素化生理盐水或自体全血。评估静脉移植物保存溶液的试验在实践和报告方面存在很大的异质性，并且现有证据的质量较低。需要高质量的试验来评估这些干预措施改善静脉旁路移植物长期通畅性的潜力。
