High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure
High-Pressure Distention of the Saphenous Vein During Preparation Results in Increased Markers of Inflammation: A Potential Mechanism for Graft Failure
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DOI：
10.1016/j.athoracsur.2011.10.035
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Anderson, Daniel R.
中科院分区：
文献类型：
--
作者：
Khaleel, Maseeha S.;Dorheim, Tracy A.;Anderson, Daniel R.
背景冠状动脉疾病是美国唯一的主要死亡原因。通常采用隐静脉（SV）或乳内动脉（IMA）作为导管的冠状动脉旁路移植术治疗。不幸的是，SV的通畅率比IMA低得多。关于为什么SV移植物比IMA移植物更常发生闭塞，存在几种假设。然而，在这方面的详细研究是有限的。本研究旨在探讨压力扩张对冠状动脉旁路移植术（CABG）中SV管道炎症反应的影响。在48例冠状动脉旁路移植术中测量了术中大隐静脉扩张压力。扩张前从导管中切除一段SV。由于静脉用于冠状动脉移植，因此将连续片段存档以供评价。采用实时荧光定量聚合酶链反应（RT-PCR）和免疫组化方法检测肿瘤组织中生物标志物的表达。各种生物标志物的上调发生。这些生物标志物包括清道夫受体A和B（SR-A、SR-B）、Toll样受体2和4（TLR 2、TLR 4）、血小板内皮细胞粘附分子（PECAM）、血管细胞粘附分子（VCAM）和细胞间细胞粘附分子（ICAM）。免疫组化结果反映了RT-PCR结果。生物标志物和压力值之间存在显著相关性。这些研究表明，炎症标志物响应SV扩张而上调。数据表明，移植物准备过程中使用的压力应加以调节，以避免炎症及其诱导移植物失败的可能性。Ann Thorac Surg 2012;93：552-8）（C）2012年，胸外科医师协会
Background. Coronary artery disease is the single leading cause of death in the United States. Commonly it is treated with coronary bypass grafting using the saphenous vein (SV) or internal mammary artery (IMA) as a conduit. Unfortunately, the SV has much lower patency rates compared with the IMA. Several hypotheses exist as to why occlusion occurs more commonly in SV grafts than in IMA grafts. However detailed studies in this area have been limited. This study investigates the effects of pressure distention on inflammation in SV conduit used in coronary artery bypass grafting (CABG).Methods. Saphenous vein distention pressure was measured intraoperatively during 48 CABG procedures. A segment of SV was excised from the conduit before distention. Because the vein was used for coronary artery grafting, sequential pieces were archived for evaluation. Real-time polymerase chain reaction (RT-PCR) and immunohistochemical analyses were performed to investigate a change in the expression of biomarkers.Results. Upregulation of various biomarkers occurred. These biomarkers included scavenger receptors A and B (SR-A, SR-B), toll-like receptors 2 and 4 (TLR2, TLR4), platelet endothelial cell adhesion molecule (PECAM), vascular cell adhesion molecule (VCAM), and intercellular cell adhesion molecule (ICAM) in segments of SV that were subjected to distention. Immunohistochemical results mirrored RT-PCR findings. A significant correlation was observed between biomarkers and pressure values.Conclusions. These studies demonstrate that markers of inflammation are upregulated in response to SV distention. The data suggest that the pressure used in graft preparation procedures should be regulated to avoid inflammation and its potential to induce graft failure. Ann Thorac Surg 2012;93:552-8) (C) 2012 by The Society of Thoracic Surgeons