Original Article Search for optimized conditions for sealing and storage of bypass vessels: influence of preservation solution and filling pressure on the degree of endothelialization
Dominik Roger Weiss, Gerd Juchem, Markus Eblenkamp, Bernhard Michael Kemkes, Brigitte Gansera, Michael Geier, Stephan Nees
Department of Transfusion Medicine and Hemostaseology , University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany; Department of Cardiac Surgery, University of Munich (LMU), 81377 Munich, Germany; Department of Medical Engineering, Technische Universität München (TUM), 85748 Garching; Department of Cardiac Surgery, Hospital Bogenhausen, 81925 Munich, Germany; Department of Physiology, University of Munich (LMU), 80336 Munich, Germany
Received December 23, 2009; accepted December, 2009; available online January 1, 2010
Abstract: The aim of the present study was to develop methods for the rapid assessment of intimal quality of coronary bypass segments of venous origin, and to prevent endothelial damage by improved intraoperative handling of graft segments. Particular attention was paid to the influence of the composition of the preservation solution and the intravasal filling pressure on the degree of endothelialization. Intravasal exposure to Alcian blue at pH<3 resulted in highly specific staining of intimal regions with functionally or structurally damaged endothelium. Standardization of preparation, staining and image acquisition of the intimal surface of graft remnants and subsequent computer-aided planimetry of these images made it possible for the first time to perform rapid serial investigations for quality control of bypass grafts. Using saline as the rinsing and intraoperative storage medium resulted in the loss of more than 50% of the endothelium at intravasal pressures of 0-100 mmHg. Increasing the pressure resulted eventually in complete de-endothelialization. In contrast, grafts incubated in a customized plasma derivative tolerated pressures of up to 200 mmHg with no significant endothelial loss; and even after exposure to 1,000 mmHg (10 times the average mean arterial pressure!) more than 70% of the endothelium were intact and vital. These findings imply strongly that the quality of aortocoronary bypass grafts of venous origin can be improved substantially by the use of a plasma derivative solution for intraoperative preservation and by monitoring and controlling the intravasal pressures reached during sealing and storage. (IJCEM912004).
Address all correspondence to: Dr. Stephan Nees Department of Physiology, University of Munich (LMU) Schillerstr. 44, 80336 Munich, Germany Tel: +49 6022 9508 Fax: +49 6022 710641 E-mail: email@example.com