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Published on: November 19, 2019
Cardioplegic storage solution: Is it the guardian of saphenous vein graft endothelium?
Nikolaos A Papakonstantinou1,2, Alexandros G Sykaras3, Christina Vourlakou3
1Cardiothoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece.
Insights
Cardioplegic solutions significantly improve vein graft endothelial integrity during storage compared to conventional solutions. This finding suggests a potential benefit for coronary artery bypass grafting (CABG) outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Organ Preservation
Background:
- Saphenous vein grafts are crucial for coronary artery bypass grafting (CABG) but have suboptimal long-term patency.
- Vein graft storage negatively impacts endothelial integrity, with existing data on optimal storage solutions being contradictory.
Purpose of the Study:
- To investigate the in vitro impact of cardioplegic solutions and storage temperature on the endothelial integrity of vein grafts.
Main Methods:
- A prospective trial involving 40 CABG patients was conducted.
- Vein graft segments were stored in either conventional heparinized blood solution or cardioplegic solution at room temperature (20-22°C) or 5°C.
- Endothelial integrity was assessed using immunohistochemistry for CD31.
Main Results:
- Cardioplegic solution storage resulted in significantly better endothelial integrity (2.83-3.10) compared to conventional solutions (2.0-2.23).
- A significant effect of cardioplegic solution and cold temperature interaction was observed.
- Storage temperature alone was not a significant factor in endothelial preservation.
Conclusions:
- Cardioplegic storage solutions offer superior endothelial preservation for vein grafts compared to conventional heparin-enriched blood solutions.
- Further clinical studies are needed to confirm if this improved preservation translates to better clinical outcomes in CABG.
Introduction:
Despite their suboptimal long-term patency, saphenous vein grafts are the most widely used conduits to achieve complete revascularization during coronary artery bypass grafting (CABG). Although vein storage critically impairs endothelial integrity, contradictory data concerning optimal storage solutions exist. The aim of this study is to explore any in vitro impact of cardioplegic solutions and temperature on vein grafts endothelial integrity during their storage.
Materials And Methods:
A single-center, prospective trial including 40 consecutive patients was conducted. Eligibility criteria included patients submitted to CABG receiving at least one vein graft. An excess segment of the graft was harvested and divided into four different parts. Each one of them was stored under different conditions; either in a conventional heparin-enriched blood solution or in a cardioplegic solution, at room temperature (20°C-22°C) and in the refrigerator (5°C). Endothelial integrity was evaluated via immunohistochemistry using an antibody against CD31.
Results:
Endothelial integrity (measured in a scale from 1-worst to 5-best) was significantly better after cardioplegic solution storage (2.83 ± 0.15 and 3.10 ± 0.13 in cold and room temperature, respectively) compared with storage in conventional solutions (2.23 ± 0.16 and 2.0 ± 0.15 in cold and room temperature, respectively). A significant effect of cardioplegic storage solution, as well as of cold temperature and cardioplegic solution interaction on endothelial preservation was reported, whereas storage temperature did not prove a significant factor by its own.
Conclusions:
Cardioplegic storage solutions result in significantly better endothelial preservation compared with conventional heparin-enriched blood solutions. The association with superior clinical outcomes remains to be proved.
