Improved Preservation of Saphenous Vein Grafts by the Use of Glyceryl Trinitrate–Verapamil Solution During Harvesting

Author:

Roubos Nick1,Rosenfeldt Franklin L.1,Richards Stephen M.1,Conyers Robert A.J.1,Davis Bruce B.1

Affiliation:

1. From the Baker Medical Research Institute (N.R., F.L.R., S.M.R.), Melbourne, and Alfred Hospital (F.L.R., R.A.J.C., B.B.D.), Melbourne, Australia.

Abstract

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 <.001, GV plus Pap versus untreated); and the results for mean pressures (mm Hg) were untreated, 136.2±9.6; Pap, 102.2±10.8; and GV, 98.0±8.3 ( P <.01, GV plus Pap versus untreated). The results for endothelial cover (%) were: untreated, 43.7±7.0; Pap, 44.1±9.2; and GV, 68.7±7.0 ( P <.05, GV versus Pap); and the results for ATP (nmol/g wet wt) were: untreated, 67.3±12.7; Pap, 112.0±19.4; and GV, 132.5±22.7 ( P <.05, GV plus Pap versus untreated). 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference28 articles.

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2. Coronary bypass graft fate

3. Campeau L Enjalbert M Lesperance J Vaislic C Grondin CM Bourassa MG. Atherosclerosis and late closure of aortocoronary saphenous vein grafts: sequential angiographic studies at 2 weeks 1 year 5 to 7 years and 10 to 12 years after surgery. Circulation . 1983;68(suppl II):II-1-II-7.

4. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts

5. Grondin CM Campeau L Lesperance J Enjalbert M Bourassa MG. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation. Circulation . 1984;70(suppl I):I-208-I-212.

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