Özcan GÜR, Demet Gür ÖZKARAMANLI, Hakan KARADAĞ, Selami GÜRKAN, Turan EGE

Comparison of vasospasm and vasodilatation response of saphenous vein grafts harvested by conventional and no-touch techniques

Amaç: Çalışmamızda izole organ banyosu düzeneğinde klasik teknik ve no-touch teknik ile hazırlanan safen ven greftlerinin (SVG) kasılma ve gevşeme yanıtları karşılaştırıldı. Çalışma planı: Şubat 2007 - Eylül 2007 tarihleri arasında, bilgilendirilmiş onam formu imzalatılarak, kliniğimizde koroner arter baypas greft (KABG) cerrahisi yapılan 12 hasta (10 erkek, 2 kadın; ort. yaş 55.6±5.8 yıl; dağılım 38-75 yıl) çalışmaya dahil edildi. Hazırlık aşamasında kullanılan teknikler göz önünde bulundurularak, greftler iki gruba ayrıldı ve SGV’ler grup 1’de (n=16) klasik teknik, grup 2’de no-touch teknik ile hazırlandı. Grup 1’de SVG çevre yağ dokulardan tamamen temizlenerek çıkarıldı. Grup 2’de SVG, safen siniri korunarak, çevresel yağ doku ile birlikte çıkarıldı. Bulgular: No-touch teknikle hazırlanan SVG’lerde gevşeme yanıtları anlamlı derecede daha yüksek bulunurken, kasılma yanıtları açısından klasik teknikle hazırlanan SVG’lerde düşük dozlarda daha yüksek kasılma değerleri elde edildi. Sonuç: Safen ven greftinin no-touch teknikle hazırlanarak kullanılmasının greft yetmezlik oranlarında azalma, ameliyat sonrası morbidite ile mortalite oranlarında azalma sağlayabileceği ve uzun dönemde daha iyi greft açık kalma oranlarının elde edilmesine yardımcı olabileceği kanısındayız.

Klasik ve no-touch teknik ile hazırlanan safen ven greftlerinde kasılma ve gevşeme yanıtlarının karşılaştırılması

Background: In this study, we aimed to compare vasoconstriction and vasodilatation responses of saphenous vein grafts (SVG) harvested by conventional and no touch techniques in tissue bath system. Methods: B etween F ebruary 2 007 a nd S eptember 2 007, 12 patients (10 males, 2 females; mean age 55.6±5.8 years; range 38 to 75 years) who underwent coronary artery bypass graft (CABG) surgery in our clinic with signed informed consents were included. Based on the techniques used during harvesting, the grafts were divided into two groups, including group 1 (n=16) with SVGs harvested by conventional technique and group 2 by no-touch technique. In group 1, SVG was removed completely from adjacent adipose tissues. In group 2, SVG was removed with adjacent adipose tissues, preserving saphenous nerves. Results: The vasodilatation response of SVGs was significantly higher with the no touch technique, while the vasoconstriction response of SVGs was significantly higher with the conventional technique at lower doses. Conclusion: We belive that no-touch harvesting technique of SVGs may decrease early graft failure and reduce also postoperative morbidity and mortality rate, contributing to improve graft patency rate in the long-term.

PDF

___

1. Buffolo E, Gerola LR. The evoluation of coronary artery grafting on the beating heart. In: Salerno TA, Ricci M, Karamanoukian HL, D’Ancona G, Bergsland J, editors. Beating heart coronary artery surgery. 1st ed. New York: Futura Publishing Company Inc; 2001. p. 3-7.
2. Lytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 1985;89:248-58.
3. Berdat PA, Müller K, Schmidli J, Kipfer B, Eckstein F, Immer FF, et al. Totally arterial off-pump vs. on-pump coronary revascularization: comparison of early outcome. Interact Cardiovasc Thorac Surg 2004;3:176-81.
4. Campeau L, Enjalbert M, Lespérance J, Bourassa MG, Kwiterovich P Jr, Wacholder S, et al. The relation of risk factors to the development of atherosclerosis in saphenousvein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery. N Engl J Med 1984;311:1329-32.
5. Kouchokos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Stenotik atherosclerotic coronary artery disease. In: Lampert RH, Geiseli B, editors. Kirklin/Barratt-Boyes Cardiac Surgery. Third Edition. Philadelphia: Churchill Livingstone; 2003. p. 353-435.
6. Roubos N, Rosenfeldt FL, Richards SM, Conyers RA, Davis BB. Improved preservation of saphenous vein grafts by the use of glyceryl trinitrate-verapamil solution during harvesting. Circulation 1995;92:II31-6.
7. Sönmez B, Arbatlı H, Demirsoy E, Yağan N, Yılmaz O, Arpaz M. Koroner arter hastalığının cerrahi tedavisi. In: Duran E, editör. Kalp ve damar cerrahisinde. 1. Baskı. İstanbul: Çapa Tıp Kitabevi; 2004. s. 1355-93.
8. Johansson BL, Souza DS, Bodin L, Filbey D, Loesch A, Geijer H, Bojö L. Slower progression of atherosclerosis in vein grafts harvested with 'no touch' technique compared with conventional harvesting technique in coronary artery bypass grafting: an angiographic and intravascular ultrasound study. Eur J Cardiothorac Surg 2010;38:414-9.
9. Sepehripour AH, Jarral OA, Shipolini AR, McCormack DJ. Does a ‘no-touch’ technique result in better vein patency? Interact Cardiovasc Thorac Surg 2011;13:626-30.
10. Biguad M, Julou-Schaeffer G, Parratt JR, Stoclet JC. Endotoxin-induced impairment of vascular smooth muscle contractions elicited by different mechanisms. Eur J Pharmacol 1990;190:185-92.
11. Sodha NR, Clements RT, Sellke FW. Vascular changes after cardiac surgery: role of NOS, COX, kinases, and growth factors. Front Biosci 2009;14:689-98.
12. Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Dreifaldt M, Souza DS. Perivascular fat-derived leptin: a potential role in improved vein graft performance in coronary artery bypass surgery. Interact Cardiovasc Thorac Surg 2011;12:170-3.