The cardiovascular system and the biochemistry of grafts used in heart surgery

Abstract

Blood is pumped into the cardiac muscle through arteries called the coronary arteries. Over time, the accumulation of cholesterol, coagulation factors, and cells on the walls of these arteries causes the walls to thicken and lose their elasticity, resulting in the development of atherosclerosis. When the blood supply of the heart is diminished by atherosclerosis, it can be restored by bypass surgery, in which atherosclerosis-free vein and/or artery grafts taken from another area of the body are used to replace the atherosclerotic vessels. These biological grafts used in surgery differ in biochemical composition and long-term patency. Although the great saphenous vein (GSV) has been the most popular graft material in revascularization for years, it has recently been superseded by the internal mammarian artery (IMA), which has a lower incidence of recurrence of atherosclerosis. The aim of the present review is briefly to address the structure of the cardiovascular system and blood vessels, and then, in the light recent data, to present the biochemical compositions and individual advantages of the graft materials used to restore an impaired blood supply to the heart.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-612) contains supplementary material, which is available to authorized users.

Long-term graft patency after coronary artery bypass grafting. Effects of morphological and pathophysiological factors

“…Over the decades, graft patency has been assessed for individual grafts alone and not for CABG as an entity per se while the dilemma of designing an optimal grafting technique in terms of graft type, harvesting, preparation, features, configuration, or anastomoses remained unsolved despite the increase in worldwide research. Literature review allowed us to classify the factors influencing graft patency into morphological (vessel type, graft length, and caliber) ( 7 , 8 ), pathophysiological (competitive flow through the native coronary artery and graft degenerative changes) ( 8 , 9 ), and surgical (technical expertise, graft harvesting and preparation, grafting design, and anastomosis technique) ( 10 - 12 ). This single center study analyzed long-term graft patency according to morphological and pathophysiological factors.…”

“…Compared with the veins, the internal thoracic arteries [left internal thoracic artery (LITA) or right internal thoracic artery (RITA)] have an extremely low attrition rate with very good long-term patency rates (96.4% >15 years) ( 6 ). The anatomical imperfection of the veins and the incapacity of performing a complete revascularization using only ITAs led to the pursuit of additional grafts [the most commonly used being a. radialis (RA), followed by a. gastroepiploica dextra, a. epigastrica inferior, a. splenica, a. ulnaris, a. subscapularis, a. gastrica sinistra , and a. circumflexa femoris lateralis ] and imagining new operative techniques in order to obtain a complete revascularization (5-6 distal anastomoses) using a limited number of grafts ( 7 ).…”

Optimal Time Repair of Ventricular Septal Rupture Post Myocardial Infarction

“…MI that can occur as a result of ischemic heart disease or coronary artery disease in conjunction, and when an atherosclerotic plaque ruptures and a developing thrombus obstructs the coronary artery completely or partly, limiting blood flow to the heart it will be manifest [ 1 , 2 ]. In this case, the primary percutaneous coronary intervention (PCI) of the coronary artery is generally provided by inserting a stent and when stents are inadequate, coronary bypass surgery is done by the left internal mammary artery or saphenous vein for revascularization [ 3 ]. The disease is diagnosed and evaluated by clinical assessment, the electrocardiogram (ECG), color Doppler Echo and left Heart Catheterization [ 4 ].…”

The effect of iloprost and sildenafil, alone and in combination, on myocardial ischaemia and nitric oxide and irisin levels

“… 1 Although the use of coronary dilator anti-aggregatory medications to various degrees is the treatment of choice in the elimination of ischaemia, 2 , 3 surgical coronary bypass methods are also used, as laid down in treatment guidelines. 4 - 6 Additionally, iloprost is the first line of treatment in occlusions seen in peripheral artery disease. 7 …”