Improved Preservation of Saphenous Vein Grafts by the Use of Glyceryl Trinitrate–Verapamil Solution During Harvesting
| Autor: | Franklin L. Rosenfeldt, Bruce B. Davis, Nick Roubos, Stephen M. Richards, Robert A.J. Conyers |
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| Rok vydání: | 1995 |
| Předmět: |
Male
Vasodilator Agents Vasodilation Distension Anastomosis Nitroglycerin Papaverine Physiology (medical) Occlusion Pressure Humans Medicine Saphenous Vein Vein Aged business.industry Middle Aged Solutions Drug Combinations medicine.anatomical_structure Verapamil Anesthesia Microscopy Electron Scanning Female Endothelium Vascular Tissue Preservation Energy Metabolism Cardiology and Cardiovascular Medicine business Compliance medicine.drug Artery |
| Zdroj: | Circulation. 92:31-36 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.92.9.31 |
| Popis: | Background High-pressure distension during harvesting damages the saphenous vein (SV) and may contribute to subsequent coronary artery bypass graft (CABG) occlusion. Application of vasodilator agents to the SV during harvesting may reduce the need for high-pressure distension and improve graft quality. We tested the effects of a vasodilator solution containing glyceryl trinitrate and verapamil (GV) or the conventional agent papaverine (Pap) on the pressure necessary to overcome SV spasm and on the structure and biochemistry of the SV graft. Methods and Results Thirty-six patients undergoing CABG were randomly allocated to receive an application of either topical and intraluminal GV solution, topical Pap, or topical and intraluminal Ringer’s solution (untreated) to the SV during harvesting. The peak and mean pressures required to distend the vein were recorded. Samples of SV were taken for microscopy and biochemical analysis just before we performed the anastomosis. The percentage of endothelial coverage was calculated by area measurements of stained en face preparations of the vein intima. The results for peak pressures (mm Hg) were: untreated, 479.2±27.5; Pap, 384.8±29.0; and GV, 309.5±28.3 ( P P P P Conclusions First, pharmacological treatment of SV during harvesting, especially with GV solution, allows the use of a lower distension pressure and reduces the breakdown of high-energy phosphates in the vein wall. Second, topical and intraluminal use of GV solution during vein harvesting improves endothelial coverage compared with the topical use of Pap or no pharmacological treatment. |
| Databáze: | OpenAIRE |
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