Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study
Pedicled no-touch saphenous vein graft harvest limits vascular smooth muscle cell activation: the PATENT saphenous vein graft study
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DOI：
10.1093/ejcts/ezt560
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发表时间：
2014-04-01
影响因子：
3.4
通讯作者：
Fremes, Stephen E.
中科院分区：
文献类型：
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作者：
Verma, Subodh;Lovren, Fina;Fremes, Stephen E.
目的：继发于血管平滑肌细胞（VSMC）活化的新生内膜增生限制了隐静脉移植物（SVG）的长期通畅性。我们比较了血管损伤和VSMC激活的标记物在SVG收获使用带蒂的“无接触”（NT）与传统的（CON）technique.METHODS：接受冠状动脉搭桥手术的患者参加了专利SVG试验（clinicaltrials.gov NCT 01488084）。患者被随机分配，从一条腿用NT技术采集SVG，从另一条腿用CON方法采集SVG。SVG节段进行形态测定，组织学和电子显微镜评估和VSMC活化和分化标记物的转录测量。腿部伤口功能恢复和收获部位并发症进行了评估，使用生活质量questionnaire.RESULTS：共17例患者（65.3 +/- 7.3岁）。使用NT与CON技术采集的SVG显示出保留的内膜、中膜和外膜结构。CON收获与大内侧Kruppel样因子4转录水平相关（0.26 +/- 0.05对0.11 +/- 0.02，P < 0.05）。CON样本具有显著较低的中血清反应因子（0.53 +/-0.11vs1.44 +/-0.50，P < 0.05）和心肌蛋白（0.59 +/-0.08vs1.33 +/-0.33，P < 0.05）转录水平。MicroRNA-145是VSMC活化和分化的抑制剂，NT组高于CON组（1.84 +/- 1.03 vs 0.50 +/- 0.19，P < 0.05）。腿部评估评分在NT腿在3个月，但类似CON scores在12 months.CONCLUSIONS：SVG收获使用“NT”技术表现出早期的分子和形态学模式与减少VSMC激活CON收获相一致。12个月时，两组的下肢功能恢复相似。需要更大规模的研究来证实这些发现。
OBJECTIVE: Neointimal hyperplasia secondary to vascular smooth muscle cell (VSMC) activation limits the long-term patency of saphenous vein grafts (SVGs). We compared markers of vascular injury and VSMC activation in SVGs harvested using the pedicled 'no-touch' (NT) vs the conventional (CON) technique.METHODS: Patients undergoing coronary artery bypass surgery were enrolled in the PATENT SVG trial (clinicaltrials.gov NCT01488084). Patients were randomly allocated to have SVGs harvested with the NT technique from one leg and the CON method from the other. SVG segments underwent morphometry, histological and electron microscopy assessments and transcript measurements of VSMC activation and differentiation markers. Leg wound functional recovery and harvest site complications were assessed using a quality-of-life questionnaire.RESULTS: A total of 17 patients (65.3 +/- 7.3 years) were enrolled. SVGs harvested using the NT vs CON technique exhibited preserved intimal, medial and adventitial architecture. CON harvest was associated with greater medial Kruppel-like factor 4 transcript levels (0.26 +/- 0.05 vs 0.11 +/- 0.02, P < 0.05). CON samples had significantly lower medial serum response factor (0.53 +/- 0.11 vs 1.44 +/- 0.50, P < 0.05) and myocardin (0.59 +/- 0.08 vs 1.33 +/- 0.33, P < 0.05) transcript levels. MicroRNA-145, an inhibitor of VSMC activation and differentiation, was higher in the NT vs CON samples (1.84 +/- 1.03 vs 0.50 +/- 0.19, P < 0.05). Leg assessment scores were worse in the NT legs at 3 months, but similar to CON scores at 12 months.CONCLUSIONS: SVGs harvested using the 'NT' technique exhibit an early molecular and morphological pattern consistent with decreased VSMC activation compared with CON harvesting. Functional leg recovery was similar in both groups at 12 months. Larger studies are required to corroborate these findings.