Grazioli Valentina, Di Mauro Michele, Gerometta PierSilvio, Parrella Barbara, Matteucci Matteo, Musazzi Andrea, Rinaldi Mauro, Sannito Marta, Panisi Paolo, Agnino Alfonso, Sweidan Elizabeth Boulos Issa, Guareschi Debora, Gaudino Mario, Corradi Domenico, Lorusso Roberto
Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, 6229 ER Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht, 6229 ER Maastricht, The Netherlands.
Interdiscip Cardiovasc Thorac Surg. 2025 Oct 6;40(10). doi: 10.1093/icvts/ivaf222.
Chronic kidney disease (CKD) is associated with metabolic dysfunctions that accelerate atherosclerosis, posing significant challenges for patients undergoing coronary artery bypass grafting (CABG). In this population, arterial calcification and reduced saphenous vein patency are common complications. This multicentre prospective study aims to evaluate the impact of renal dysfunction on the histological characteristics of arterial and venous grafts used in CABG.
Vascular graft specimens collected during CABG were prospectively analysed and stratified into 3 groups based on renal function, according to established publications: Group 1 (glomerular filtration rate [GFR] ≥90 mL/min/1.73 m2), Group 2 (GFR 60-89 mL/min/1.73 m2), and Group 3 (GFR ≤59 mL/min/1.73 m2). Formalin-fixed samples were histologically assessed for intimal thickening (Grade 0-3), fibroelastosis, and vasa vasorum density.
A total of 324 arterial grafts (Group 1: 100; Group 2: 134; Group 3: 90) and 289 vein grafts (Group 1: 86; Group 2: 119; Group 3: 84) were analysed, including 5 arterial and venous grafts from dialysis patients. No significant structural differences were observed between groups. Intimal thickening rates were comparable across renal function stages. Fibroelastosis was more prevalent in venous grafts (56%-64%) than in arterial grafts (10%-15%).
This study assesses graft histology in CABG patients stratified by renal function. At surgery, CKD does not appear to significantly alter graft structure. Further studies are warranted to explore long-term graft outcomes in this population.
慢性肾脏病（CKD）与加速动脉粥样硬化的代谢功能障碍相关，给接受冠状动脉旁路移植术（CABG）的患者带来重大挑战。在这一人群中，动脉钙化和大隐静脉通畅率降低是常见并发症。这项多中心前瞻性研究旨在评估肾功能不全对CABG中使用的动脉和静脉移植物组织学特征的影响。
根据已发表的文献，对CABG期间收集的血管移植物标本进行前瞻性分析，并根据肾功能分为3组：第1组（肾小球滤过率[GFR]≥90 mL/min/1.73 m²）、第2组（GFR 60 - 89 mL/min/1.73 m²）和第3组（GFR≤59 mL/min/1.73 m²）。对福尔马林固定的样本进行组织学评估，以确定内膜增厚情况（0 - 3级）、纤维弹性组织变性和血管滋养管密度。
共分析了324个动脉移植物（第1组：100个；第2组：134个；第3组：90个）和289个静脉移植物（第1组：86个；第2组：119个；第3组：84个），其中包括5个来自透析患者的动脉和静脉移植物。各组之间未观察到明显的结构差异。内膜增厚率在不同肾功能阶段相当。纤维弹性组织变性在静脉移植物（56% - 64%）中比在动脉移植物（10% - 15%）中更普遍。
本研究评估了按肾功能分层的CABG患者的移植物组织学。在手术时，CKD似乎并未显著改变移植物结构。有必要进一步研究探索这一人群中移植物的长期结局。
