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Coronary endothelial injury after local occlusion on the human beating heart
H B Hangler1, K Pfaller, H Antretter
1Department of Cardiac Surgery and Institute of Anatomy and Histology, Leopold-Franzens-University, Innsbruck, Austria. herbert.hangler@uibk.ac.at
Insights
Beating heart surgery can injure coronary arteries. Local occlusion during surgery causes endothelial damage, plaque rupture, and microthrombus formation in human coronary arteries.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Pathology
Background:
- Beating heart surgery involves temporary occlusion of coronary arteries, potentially causing mechanical trauma and endothelial injury.
- Understanding the impact of this occlusion on the arterial wall is crucial for patient outcomes.
Purpose of the Study:
- To investigate the effects of local coronary artery occlusion on the beating heart in human subjects.
- To assess the extent and nature of endothelial injury induced by surgical occlusion.
Main Methods:
- Human coronary arteries from patients undergoing heart transplantation (dilated cardiomyopathy or ischemic heart disease) were studied.
- Local occlusion was applied to segments of coronary arteries, with unoccluded segments serving as controls.
- Scanning electron microscopy was used to evaluate the integrity of the endothelial lining.
Main Results:
- Significantly greater endothelial injury was observed in occluded segments compared to control segments.
- In atherosclerotic specimens, local occlusion led to plaque rupture (3/34), side branch injury (2/44), and microthrombus formation (6/44).
Conclusions:
- Local occlusion of coronary arteries during beating heart surgery can result in endothelial denudation.
- The procedure may also trigger adverse events such as microthrombosis, atherosclerotic plaque rupture, and injury to side branches.
Background:
Occlusion of coronary arteries during beating heart surgery bears the potential for mechanical trauma to the arterial wall with consequent endothelial injury. The aim of this study was to elucidate the effects of local occlusion on the beating heart in human coronary arteries.
Methods:
Coronary arteries of patients with dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 10) undergoing heart transplantation were locally occluded after starting cardiopulmonary bypass. Immediately after excision of the diseased heart, the vessels were fixed. Unoccluded segments served as controls. Integrity of endothelial lining was observed with scanning electron microscopy.
Results:
Scanning electron microscopy revealed significantly more severe endothelial injury in the area of occlusion than in the adjacent, not manipulated control segments. In the region of local occlusion, plaque rupture was noted in three of 34 atherosclerotic vessel specimens, injury to side branches was evident in two of 44, and local microthrombus formation was evident in six of 44 samples.
Conclusions:
Local occlusion of human coronary arteries during beating heart coronary surgery may cause focal endothelial denudation, local microthrombosis, atherosclerotic plaque rupture, and injury to target vessel side branches.