Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?

Abstract

Introduction: 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. Materials and Methods: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.Results: 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. Conclusions: 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. K E Y W O R D S cardioplegic solution, coronary artery bypass grafting, saphenous vein graft, storage solutions, vein graft failure 1272-7990 How to cite this article: Papakonstantinou NA, Sykaras AG, Vourlakou C, Goudevenos J, Papadopoulos G, Apostolakis E. Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium? J Card Surg. 2020;35:996-1003.

Storage solutions to improve grafts preservation and longevity in coronary artery bypass grafting surgery: hype or hope?

“…In a recent study, Papakonstantinou et al compared a high potassium, crystalloid cardioplegia solution to AHB for SVG preservation in an ex vivo study with human SVGs. They reported that the cardioplegia solution resulted in significantly better endothelial preservation as measured via immunohistochemistry (see above for study details) [20].…”

“…For instance, Papakonstantinou et al compared the storage of 160 SVG segments from 40 consecutive patients in AHB to crystalloid cardioplegia at both cold (58C) and room temperature (20-258C) and evaluated endothelial integrity via immunohistochemistry. On a Likert-type scale of 1 (worst) to 5 (best), endothelial integrity was significantly better after storage in cardioplegic solution irrespective of temperature (58C: 2.83 AE 0.15 vs. 2.23 AE 0.16; P ¼ 0.0022; 20-258C: 3.10 AE 0.13 vs. 2.0 AE 0.15; P < 0.0001)[20]. Furthermore, in a retrospective, nonrandomized, observational analysis of 1828 patients and 4343 SVG from the PREVENT IV trial, Harskamp and colleagues reported that AHB was associated with higher VGF at 1 year as compared to buffered saline in both patient-level (odds ratio,Fouquet et al demonstrated that AHB had significantly lower rates of graft thrombosis at 6 weeks in an in vivo rat model as compared to the buffered solution L-glutathione, L-ascorbic acid, L-arginine and D-glucose (GALA) (22% vs. 83.3%; P ¼ 0.04) [22].…”