Storage of saphenous vein grafts prior to coronary artery bypass grafting: is autologous whole blood more effective than saline in preserving graft function?

Tsakok, Maria; Montgomery-Taylor, Sarah

doi:10.1093/icvts/ivs275

Cited by 31 publications

(35 citation statements)

References 9 publications

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“…It was concluded that room-temperature saline was detrimental to vascular endothelium, and both normal saline and autologous whole blood impair smooth muscle function, relative to a buffered saline solution such as University of Wisconsin solution. 18 …”

Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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Introduction Recent clinical data suggests intraoperative preservation of human saphenous vein (HSV) in normal saline is associated with vein graft failure. We evaluated the influence of several preservation media on acute physiologic function and cellular viability of HSV conduit. Methods Unprepared (UP) HSV obtained from coronary artery bypass graft patients was characterized on a muscle bath after two hour storage in Plasma-Lyte A, normal saline, University of Wisconsin solution, Celsior solution, autologous whole blood, or glutathione-ascorbic acid- L-arginine (GALA) solution. Vascular smooth muscle contractility to depolarizing KCl and phenylephrine was assessed. The relaxation of phenylephrine-pre-contracted HSV to sodium nitroprusside and carbachol (endothelial-independent and -dependent relaxation, respectively) was also assessed. Cellular viability was determined via the methyl thiazolyl tetrazolium (MTT) assay. Rat aortae were used to assess the effect of pH during graft preservation on endothelial-dependent relaxation. Results Preservation of HSV in normal saline and autologous whole blood impaired contractile responses to KCl relative to UP tissues, while University of Wisconsin solution and Celsior solution preservation enhanced contractile responses (P<.05). Relative to UP tissues, responses to phenylephrine were decreased with preservation in normal saline, while preservation in University of Wisconsin solution, Celsior solution and GALA all potentiated these responses (P<.05). Only normal saline preservation impaired endothelial-independent relaxation (P=.005). Preservation in Plasma-Lyte A (P=.02), normal saline (P=.002) and University of Wisconsin solution (P=.02) led to impaired endothelial-dependent relaxation. Normal saline preservation led to a decreased MTT viability index relative to UP tissues (0.021±0.002 mg−10.5 mL−1 vs. 0.033±0.005 mg−10.5 mL−1; P=.03). Endothelial function was impaired by acidic pH in rat aorta. Conclusions Normal saline preservation causes graft injury leading to impaired physiologic function and decreased viability of HSV. This harm to the conduit is mitigated by the use of buffered salt solutions as preservation media.

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Section: Discussionmentioning

confidence: 99%

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Wise

Hocking

Eagle

et al. 2015

Surgery

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“…Although in vitro and animal models have suggested that these vein graft preservation solutions may have important differences, they have not been compared in clinical studies. 3 We performed an observational comparative-effectiveness evaluation of various vein graft preservation solutions using data from a large randomized clinical trial of patients undergoing CABG surgery. We described the patterns of use of vein graft preservation solutions in clinical practice.…”

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confidence: 99%

Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

et al. 2014

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IMPORTANCE In vitro and animal model data suggest that intraoperative preservation solutions may influence endothelial function and vein graft failure (VGF) after coronary artery bypass graft (CABG) surgery. Clinical studies to validate these findings are lacking. OBJECTIVE To evaluate the effect of vein graft preservation solutions on VGF and clinical outcomes in patients undergoing CABG surgery. DESIGN, SETTING, AND PARTICIPANTS Data from the Project of Ex-Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) study, a phase 3, multicenter, randomized, double-blind, placebo-controlled trial that enrolled 3014 patients at 107 US sites from August 1, 2002, through October 22, 2003, were used. Eligibility criteria for the trial included CABG surgery for coronary artery disease with at least 2 planned vein grafts. INTERVENTIONS Preservation of vein grafts in saline, blood, or buffered saline solutions. MAIN OUTCOMES AND MEASURES One-year angiographic VGF and 5-year rates of death, myocardial infarction, and subsequent revascularization. RESULTS Most patients had grafts preserved in saline (1339 [44.4%]), followed by blood (971 [32.2%]) and buffered saline (507 [16.8%]). Baseline characteristics were similar among groups. One-year VGF rates were much lower in the buffered saline group than in the saline group (patient-level odds ratio [OR], 0.59 [95% CI, 0.45-0.78; P < .001]; graft-level OR, 0.63 [95% CI, 0.49-0.79; P < .001]) or the blood group (patient-level OR, 0.62 [95% CI, 0.46-0.83; P = .001]; graft-level OR, 0.63 [95% CI, 0.48-0.81; P < .001]). Use of buffered saline solution also tended to be associated with a lower 5-year risk for death, myocardial infarction, or subsequent revascularization compared with saline (hazard ratio, 0.81 [95% CI, 0.64-1.02; P = .08]) and blood (0.81 [0.63-1.03; P = .09]) solutions. CONCLUSIONS AND RELEVANCE Patients undergoing CABG whose vein grafts were preserved in a buffered saline solution had lower VGF rates and trends toward better long-term clinical outcomes compared with patients whose grafts were preserved in saline- or blood-based solutions.

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“…To enhance the anticoagulant effect of these solutions, heparin is often added to the solution [5]. The action of antithrombin is accelerated by 1,000 times under the existence of heparin; thus, the effectiveness of the anticoagulation mechanism of heparin increases rapidly.…”

Section: Discussionmentioning

confidence: 99%

“…To enhance the anticoagulant effect of these solutions, heparin is often added to these solutions [5]. …”

Section: Introductionmentioning

confidence: 99%

Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?

Yoon

Kim

et al. 2013

Korean J Thorac Cardiovasc Surg

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BackgroundGraft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine.MethodsSprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats.ResultsThe anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group.ConclusionNM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.

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Storage of saphenous vein grafts prior to coronary artery bypass grafting: is autologous whole blood more effective than saline in preserving graft function?

Cited by 31 publications

References 9 publications

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Preservation solution impacts physiologic function and cellular viability of human saphenous vein graft

Vein Graft Preservation Solutions, Patency, and Outcomes After Coronary Artery Bypass Graft Surgery

Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?

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