Özcan GÜR, Orkut GÜÇLÜ, Volkan YÜKSEL, Selami GÜRKAN

Comparison of vasodilatation responses of arterial grafts harvested with and without electrocautery: in vitro study results

Amaç: Bu çalışmada, elektrokoterli ve elektrokotersiztekniklerle hazırlanan arter greftlerinin vazodilatasyonyanıtları organ banyosu düzeneği kullanılarakkarşılaştırıldı. Çalışma planı: Mayıs 2013 - Haziran 2014 tarihleriarasında elektif koroner arter baypas greft (KABG)cerrahisi uygulanan 30 hasta (19 erkek, 11 kadın, ort.yaş 60.0±8.2 yıl; dağılım 47-77 yıl) çalışmaya alındı. Hergruptan 16şar internal torasik arter ve radial arter örneğialındı. Greftler iki gruba ayrıldı: elektrokoter kullanılarakhazırlanan greftler (grup 1) ve elektrokotersiz hazırlanangreftler (grup 2). Bul gu lar: İnternal torasik arter greftlerinin vazodilatasyonyanıtları, grup 2ye kıyasla, grup 1de anlamlı olarak azaldı.Radial arter greftlerinin vazodilatasyon yanıtları grup 1degrup 2den düşük olmasına rağmen, fark istatistiksel olarakanlamlı değildi. So nuç: Elektrokoter ile damar preparasyonu, radial artergreftlerinden ziyade, internal torasik arter greftlerindeciddi endotel hasarına neden olur. Erken greftyetmezliğinin önlenmesi açısından, arter greftlerininhazırlanması esnasında elektrokotersiz işlem dahaavantajlı olabilir.

Elektrokoter ile veya elektrokotersiz hazırlanan arter greftlerinin vazodilatasyon yanıtlarının karşılaştırılması: İn vitro çalışma sonuçları

Background: In this study, we aimed to comparevasodilatation responses of arterial grafts harvested byelectrocautery and without electrocautery by using thetissue bath system. Methods: Between May 2013 and June 2014, 30 patients(19 males, 11 females, mean age 60.0±8.2 years; range 47to 77 years) who underwent elective coronary artery bypassgrafting (CABG) surgery were enrolled in the study. Sixteensamples from internal thoracic artery and radial arterygrafts in each group were collected. The grafts were dividedinto two groups: grafts harvested by electrocautery (group 1)and grafts harvested without electrocautery (group 2). Results: The vasodilatation responses of internal thoracicartery grafts were significantly reduced in group 1,compared to group 2. Although the vasodilatationresponses of radial artery grafts in group 1 were lesser thanin group 2, the difference was not statistically significant. Conclusion: Vessel harvesting by electrocautery maycause serious endothelial injury particularly in internalthoracic artery grafts, rather than radial artery grafts.The procedure without electrocautery may be moreadvantageous during the harvesting of arterial grafts interms of preventing early graft failure.

PDF

___

1. Murray G, Porcheron R, Hilario J, Roschlau W. Anastomosis of systemic artery to the coronary. Can Med Assoc J 1954;71:594-7.
2. Green GE. Internal mammary artery-to-coronary artery anastomosis. Three-year experience with 165 patients. Ann Thorac Surg 1972;14:260-71.
3. Barner HB, Standeven JW, Reese J. Twelve-year experience with internal mammary artery for coronary artery bypass. J Thorac Cardiovasc Surg 1985;90:668-75.
4. Loop FD, Lytle BW, Cosgrove DM, Stewart RW, Goormastic M, Williams GW, et al. Influence of the internal-mammary- artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1-6.
5. Carpentier A, Guermonprez JL, Deloche A, Frechette C, DuBost C. The aorta-to-coronary radial artery bypass graft. A technique avoiding pathological changes in grafts. Ann Thorac Surg 1973;16:111-21.
6. Curtis JJ, Stoney WS, Alford WC Jr, Burrus GR, Thomas CS Jr. Intimal hyperplasia. A cause of radial artery aortocoronary bypass graft failure. Ann Thorac Surg 1975;20:628-35.
7. Fisk RL, Brooks CH, Callaghan JC, Dvorkin J. Experience with the radial artery graft for coronary artery bypass. Ann Thorac Surg 1976;21:513-8.
8. Acar C, Jebara VA, Portoghese M, Beyssen B, Pagny JY, Grare P, et al. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992;54:652-9.
9. He GW. Arterial grafts: clinical classification and pharmacological management. Ann Cardiothorac Surg 2013;2:507-18.
10. Ronan JW, Perry LA, Barner HB, Sundt TM. Radial artery harvest: comparison of ultrasonic dissection with standard technique. Ann Thorac Surg 2000;69:113-4.
11. Cheng Z, Zhao Z, Quan X, Wang S, Zhao J, Sun J, et al. Twelve years' experience and clinical results of using the radial artery for coronary revascularization. Chin Med J (Engl) 2014;127:887-92.
12. Hayward PA, Buxton BF. Contemporary coronary graft patency: 5-year observational data from a randomized trial of conduits. Ann Thorac Surg 2007;84:795-9.
13. Chardigny C, Jebara VA, Acar C, Descombes JJ, Verbeuren TJ, Carpentier A, et al. Vasoreactivity of the radial artery. Comparison with the internal mammary and gastroepiploic arteries with implications for coronary artery surgery. Circulation 1993;88:115-27.
14. He GW. Verapamil plus nitroglycerin solution maximally preserves endothelial function of the radial artery: comparison with papaverine solution. J Thorac Cardiovasc Surg 1998;115:1321-7.
15. Lehtola A, Verkkala K, Järvinen A. Is electrocautery safe for internal mammary artery (IMA) mobilization? A study using scanning electron microscopy (SEM). Thorac Cardiovasc Surg 1989;37:55-7.
16. He GW, Liu ZG. Comparison of nitric oxide release and endothelium-derived hyperpolarizing factor-mediated hyperpolarization between human radial and internal mammary arteries. Circulation 2001;104:344-9.
17. He GW, Fan L, Grove KL, Furnary A, Yang Q. Expression and function of endothelial nitric oxide synthase messenger RNA and protein are higher in internal mammary than in radial arteries. Ann Thorac Surg 2011;92:845-50.
18. Georghiou GP, Stamler A, Berman M, Sharoni E, Vidne BA, Sahar G. Advantages of the ultrasonic harmonic scalpel for radial artery harvesting. Asian Cardiovasc Thorac Ann 2005;13:58-60.
19. Dumantepe M, Kehlibar T, Güllü AU, Arslan Y, Yılmaz M, Berköz K, et al. Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting; an electron microscopic evaluation. Anadolu Kardiyol Derg 2011;11:250-6.
20. Oz BS, Mataraci I, Iyem H, Kuralay E, Doganci S, Demirkilic U, et al. Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting: clinical research. Thorac Cardiovasc Surg 2007;55:104-7.
21. Yoshikai M, Ito T, Kamohara K, Yunoki J. Endothelial integrity of ultrasonically skeletonized internal thoracic artery: morphological analysis with scanning electron microscopy. Eur J Cardiothorac Surg 2004;25:208-11.