Ünal USLU, Süheyla GONCA, Alev CUMBUL, Onur SEN

Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması

Amaç: Koroner arter grefti olarak kullanılan safen venin hazırlanmasında farklı cerrahi toplama teknikleri kullanılmaktadır. Bu çalışmanın amacı koroner arter baypas greftlemesi (KABG) için kullanılan safen ven hazırlama işlemlerinden geleneksel yöntem ile “no-touch” tekniği arasında apoptotik indeks açısından farklılığı araştırmaktır. Gereç ve Yöntemler: KABG uygulanan 40 hastada geleneksel ve “no-touch” cerrahi yöntemleri kullanılarak toplanan safen venlerde apopitoz bakılarak prospektif, randomize bir klinik çalışma yapıldı. Toplanan safen ven parçaları paraformaldehitte bekletilerek tespit edildi. Kriyo cihazı ile 5 mikrometre kalınlığında kesitler alındı. Örnekler modifiye TUNEL yöntemi ile işaretlenerek apopitotik hücre ölümleri gösterildi. Doku kesitlerindeki TUNEL (+) ve (-) hücreler Stereo Investigator version 7.5 görüntü işleme yazılımı kullanılarak tarafsız ve eşit 100 çerçeveye optik olarak bölünmüş alanlarda sayıldı. Apoptotik indeks; Hücre / Toplam Hücre oranı kullanılarak hesaplandı. Sonuçlar bağımsız gruplarda t testi ile istatistiksel olarak değerlendirildi.Bulgular: Geleneksel yöntem ile “no-touch” tekniği apoptotik indeksleri karşılaştırıldı. Geleneksel tekniğin uygulandığı grubunun apoptotik indeksi “no-touch” tekniği uygulanan diğer gruba göre anlamlı oranda yüksek bulundu. Mekanik ve yapısal koruma venin etrafını kuşatan yastıkçıklar tarafından sağlanmaktadır. Bu yastıkçıklarda apoptotik hücre ölümünün daha az görülmesi safen vendeki doku hasarının daha az olduğunu gösterir. Sonuç: Safen ven grefti hazırlamasında geleneksel yöntem yerine ‘no-touch’ cerrahi tekniğinin tercih edilmesi ile doku hasarı ve vazospazm oluşumunun azalabileceği ve baypas sonrası greftin açık kalma olasılığının artabileceği sonucuna ulaşıldı.

Anahtar Kelimeler:

Safen ven, koroner damar baypas, apopitoz

Apoptotic Index of the Saphenous Vein Using Different Harvesting Methods for a Coronary Artery Bypass Graft

Aim: Different surgical harvesting techniques are applied to prepare the saphenous vein which is used as a coronary artery graft. The aim of this study is to investigate two different surgical techniques, the conventional and no-touch, which are used in coronary artery bypass grafting (CABG), in the preparation for saphenous vein by comparing the apoptotic index results. Material and Methods: A prospective, randomized clinical study comparing 2 different saphenous vein harvesting techniques, the conventional and no-touch methods, was performed with 40 patients who underwent CABG. Small pieces of the SV tissues were fixed for paraformaldehyde. Up to 5 - µm - thick cryosections were obtained with a cryostat. Samples have labeled with modified TUNEL method and apoptotic cell deaths were shown. TUNEL (+) and (-) cells were determined in tissue sections and counted in unbiased and equal 100 frames optically divided areas by using the Stereo Investigator version 7.5 image analysis software. The apoptotic index was calculated as the ratio of apoptotic cells/total cells. Findings were statistically analyzed by using the independent sample t test. Results: The apoptotic index of the conventional method and the no-touch surgical technique were compared. The conventional technique apoptotic index results were significantly higher than that no-touch technique group. Mechanical and structural protection is provided by the cushions surrounding the vein. Less apoptotic cell death in these cushions means less tissue damage in the saphenous vein. The fact that the cushions which provide venous, mechanical and structural support are more stable shows that apoptotic cell death in the 'no-touch' technique group is less than the other groups.Conclusion: It was concluded that, in saphenous vein graft preparation, preferring the “no-touch” surgical technique instead of conventional method could decrease tissue injury and vasospasm and the possibility of the graft to remain open after bypass could increase.

Keywords:

Saphaneous vein, apoptosis, coronary artery bypass,

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