IMPROVED PRESERVATION OF SAPHENOUS-VEIN GRAFTS BY THE USE OF GLYCERYLTRINITRATE VERAPAMIL SOLUTION DURING HARVESTING

Citation
N. Roubos et al., IMPROVED PRESERVATION OF SAPHENOUS-VEIN GRAFTS BY THE USE OF GLYCERYLTRINITRATE VERAPAMIL SOLUTION DURING HARVESTING, Circulation, 92(9), 1995, pp. 31-36
Citations number
28
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
31 - 36
Database
ISI
SICI code
0009-7322(1995)92:9<31:IPOSGB>2.0.ZU;2-H
Abstract
Background High-pressure distension during harvesting damages the saph enous vein (SV) and may contribute to subsequent coronary artery bypas s graft (CABG) occlusion. Application of vasodilator agents to the SV during harvesting may reduce the need for high-pressure distension and improve graft quality. We tested the effects of a vasodilator solutio n containing glyceryl trinitrate and verapamil (GV) or the conventiona l agent papaverine (Pap) on the pressure necessary to overcome SV spas m and on the structure and biochemistry of the SV graft.Methods and Re sults Thirty-six patients undergoing CABG were randomly allocated to r eceive an application of either topical and intraluminal GV solution, topical Pap, or topical and intraluminal Ringer's solution (untreated) to the SV during harvesting. The peak and mean pressures required to distend the vein were recorded. Samples of SV were taken for microscop y and biochemical analysis just before we performed the anastomosis. T he percentage of endothelial coverage was calculated by area measureme nts of stained en face preparations of the vein intima. The results fo r peak pressures (mm Hg) were: untreated, 479.2+/-27.5; Pap, 384.8+/-2 9.0; and GV, 309.5+/-28.3 (P<.001, GV plus Pap versus untreated); and the results for mean pressures (mm Hg) were untreated, 136.2+/-9.6; Pa p, 102.2+/-10.5; and GV, 95.0+/-8.3 (P<.01, GV plus Pap versus untreat ed). The results for endothelial cover (%) were: untreated, 43.7+/-7.0 ; Pap, 44.1+/-9.2; and GV, 6817+/-7.0 (P<.05, GV versus Pap); and the results for ATP (nmol/g wet wt) were: untreated, 67.3+/-12.7; Pap, 112 .0+/-19.4; and GV, 132.5+/-22.7 (P<.05, GV plus Pap versus untreated). Conclusions First, pharmacological treatment of SV during harvesting, especially with GV solution, allows the use of a lower distension pre ssure and reduces the breakdown of high-energy phosphates in the vein wall. Second, topical and intraluminal use of GV solution during vein harvesting improves endothelial coverage compared with the topical use of Pap or no pharmacological treatment.