Ali Vefa ÖZCAN, Ferda BİR, İbrahim GÖKŞİN, Mustafa SAÇAR, Gökhan ÖNEM, Ahmet BALTALARLI

Koroner baypasta in-situ safen ven grefti hazırlanması intimal hasarı azaltır mı?

Amaç: Koroner bypass cerrahisi (CABG) sırasında safen ven grefti hazırlanırken gerek cerrahi manüplasyonlara bağlı, gerekse organ banyosunda iskemik ortamda bekletilmeye bağlı intimal hasar oluşmaktadır. İn-situ teknik ile damar endotelinin iskemiden korunacağı ve intimal hasarın azalacağı öngörüsü ile prospektif bir çalışma planlandı. Gereç ve Yöntemler: CABG yapılacak ardışık 40 hastadan hazırlanan safen ven grefti çalışmaya alındı. Yirmişer hastadan oluşan iki grup oluşturuldu. Grup-1'de geleneksel "açık cilt kesiği tekniğiyle" safen ven grefti hazırlandı ve papaverinli organ banyosunda 45 dk. bekletildi. Grup-2'de in-situ teknikle safen ven grefti hazırlandı ve etrafına papaverinli spanç sarılarak 45 dk. bekletildi. Histopatolojik değerlendirme için, greftlerin distal uç kısmından 1 cm'lik safen parçası alındı. Doku örnekleri hemotoksilin-eosin ile boyanarak ışık mikroskopisinde incelendi ve histopatolojik olarak skorlandı. İstatistiksel değerlendirmede ki-kare testi kullanıldı. Bulgular: Her iki grupta da safen ven örneklerinden elde edilen patolojik hasar median skorları 2 bulundu ve istatistiksel fark saptanmadı (p = 0.987). Her iki grupta da hafif-orta derecede intimal desquamasyon saptandı. Sonuç: İn-situ teknikle safen ven grefti hazırlama geleneksel açık cilt kesiği tekniğiyle hazırlamaya intimal hasar bakımından üstün değildir.

Does in-situ saphenous vein graft harvesting decrease intimal injury in coronary bypass surgery

Objective: Surgical manuplations during harvesting saphenous vein graft (SVG) and application of organ bath for CABG causes intimal injury. A prospective study was performed with the postulation that in-situ harvesting technique would protect the graft from ischemic injury and decrease the intimal injury on of the endotelium. Materials and Methods: This study includes consecutive forty patients who underwent SVG harvesting for CABG. Two group each consisting 20 patients were formed. In group-1, SVG was harvested using the conventional open technique and kept for 45 minutes in papaverine organ-bath. In group-2, SVG was harvested by the in-situ technique and kept within a sponge soaked with papaverine for 45 minutes. 1 cm samples were taken from the distal end of the graft for the histopathological examination and were scored under light microscopy. Chi-square test was used for statistical analysis. Results: It was found that the median scores of pathological injury were 2 in both groups. There was no statistical difference between the two groups in respect to the scores of pathological injury (p = 0.987). Mild-moderate degree intimal desquamation was found in the two groups. Conclusion: In-situ saphenous vein graft harvesting does not have any advatage over the conventional open technique with respect to intimal injury.

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