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Effects of cardioplegic solutions on the vasoreactivity of the internal mammary artery
C I Chardigny1, V A Jebara, T J Verbeuren
1Department of Cardiovascular Surgery, Broussais Hospital, Paris, France.
Insights
Blood cardioplegia appears less harmful to internal mammary artery grafts than other solutions, preserving vascular function. Storage in cardioplegic solutions impacts arterial graft vasoreactivity and endothelial function.
Area of Science:
- Cardiovascular Surgery
- Vascular Biology
- Organ Preservation
Background:
- Internal mammary artery (IMA) grafting is a common cardiac surgical procedure.
- Cardioplegia is administered via the IMA during grafting.
- The impact of cardioplegic solutions on IMA graft function is not fully understood.
Purpose of the Study:
- To investigate the effects of different cardioplegic solutions on IMA graft vasoreactivity.
- To assess potential endothelial damage caused by cardioplegic solutions.
- To compare the functional outcomes of IMA segments stored in various solutions.
Main Methods:
- Segments of IMA from 10 patients were used.
- Forty IMA segments were incubated in four solutions: Krebs, University of Wisconsin (UW), Broussais Hospital (BH), and blood cardioplegia.
- Vascular reactivity was assessed using norepinephrine and acetylcholine.
Main Results:
- IMA segments in Krebs solution showed different norepinephrine sensitivity compared to UW and BH solutions.
- Acetylcholine-induced relaxation varied significantly between Krebs solution and the other three solutions, and between blood cardioplegia and UW/BH solutions.
- No significant differences in sodium nitroprusside-induced relaxation were observed across solutions.
Conclusions:
- Storage in cardioplegic solutions does not preserve the initial vasoreactivity of the IMA.
- Blood cardioplegia demonstrates a less detrimental effect on endothelial and myogenic vascular function compared to other solutions.
- These findings suggest blood cardioplegia may be preferable for maintaining IMA graft viability.
Background:
During free internal mammary artery grafting, cardioplegia administration can be performed through the internal mammary artery. The present study examined whether cardioplegic solutions produce arterial graft constriction and functional endothelial damage.
Methods:
Forty internal mammary artery segments from 10 patients were incubated in Krebs solution (n=10), University of Wisconsin solution (n=10), Broussais Hospital solution (n=10), or blood cardioplegia (n=10).
Results:
There was a significant difference in sensitivity to norepinephrine between segments in Krebs solution and those in University of Wisconsin solution or Broussais Hospital solution but not segments in blood cardioplegia. There was a significant difference in relaxation to acetylcholine between segments in Krebs solution and those in the three other cardioplegic solutions and between those in blood cardioplegia and segments in University of Wisconsin solution or Broussais Hospital solution. There was no significant difference in relaxation to sodium nitroprusside between segments in any of the solutions.
Conclusions:
These experiments suggest that storage in the different cardioplegic solutions studied does not preserve the initial vasoreactivity of the internal mammary artery. However, blood cardioplegia appears to be less deleterious in regard to endothelial and myogenic vascular function.