Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicardial coronary arteries
Temporary coronary artery occlusion during off-pump coronary artery bypass grafting with the new poloxamer P407 does not cause endothelial dysfunction in epicardial coronary arteries
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DOI：
10.1016/j.jtcvs.2006.04.028
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发表时间：
2006-11-01
影响因子：
6
通讯作者：
Perrault, Louis P.
中科院分区：
文献类型：
--
作者：
Bouchot, Olivier;Aubin, Marie-Claude;Perrault, Louis P.
目的：研究新型可逆性热敏凝胶poloxam407在微创手术中冠脉闭塞的疗效及其对冠状动脉内皮的影响。方法：用波洛沙姆闭塞猪左前降支或右冠状动脉。左、右胸内动脉作为移植物进行冠状动脉旁路手术。动物在灌注3小时（急性，n = 8）或3天后（亚急性，n = 6）被人道杀死。评价冠状动脉血管反应性对血清素和缓激素的反应。组织学研究分析心肌细胞坏死和内皮覆盖。结果：凝胶导致闭塞7.8 +/- 2.2分钟。冠脉闭塞段的浓度-反应曲线显示，两组血管内皮依赖性舒张程度无差异（P < 0.05）。组织学研究显示急性组冠状动脉闭塞后心肌细胞无坏死；在亚急性组的1只动物中发现了一个小的梗死区，这是由第一对角分支闭塞引起的。两组均保持内皮层覆盖。结论：波洛沙姆407是一种很有前途的技术，可以在心脏冠状动脉手术中搭桥时在吻合处止血，而不会损伤内皮细胞或造成缺血后果。
Objective: The aim of this study was to assess the efficacy of the novel reversible thermosensitive gel poloxamer 407 for occlusion of the coronary vessel necessary for minimally invasive operations and its effects on coronary endothelium.Methods: Domestic swine were submitted to occlusion of the left anterior descending or right coronary artery using the poloxamer. The left and right internal thoracic arteries were used as grafts to perform coronary artery bypasses. Animals were humanely killed after 3 hours of perfusion (acute; n = 8) or 3 days (subacute; n = 6). The vascular reactivity of coronary artery was evaluated in response to serotonin and bradykinin. Histologic studies were performed to analyze cardiomyocyte necrosis and endothelial coverage.Results: The gel led to an occlusion of 7.8 +/- 2.2 minutes. Concentration-response curves of occluded coronary segments showed no difference of endothelium-dependent relaxations in both operated groups (P < .05 vs control). Histologic studies demonstrated the absence of cardiomyocyte necrosis after coronary artery occlusion in the acute group; a small infarct zone was detected in 1 animal in the subacute group, resulting from an occlusion of the first diagonal branch. The endothelial layer coverage was preserved in both groups.Conclusion: The poloxamer 407 represents a promising technique for obtaining hemostasis at the site of anastomosis during construction of bypasses during beating heart coronary artery surgery, without damage to the endothelium or ischemic consequence.