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OBJECTIVESWe aimed to determine the extent of acute endothelial cell loss and neointimal proliferation in the long-term in saphenous vein grafts (SVGs) exposed to defined distension pressures.METHODSDuring routine competence testing of SVGs for coronary artery bypass grafting (CABG), blinded peak pressure measurements were performed in 10 patients. In an experimental set-up, distension pressure-related endothelial damage was studied in the SVGs of 20 patients. In a subgroup (n10), each patient's SVG was divided into segments and subjected to four constant pressures (50, 100, 150 and 300mmHg) for 30min each. In another subgroup (n10), SVGs were exposed to a short phase of high pressure (low pressure followed by 300mmHg for 5min). Acute endothelial cell loss was quantified by CD31-immunostaining. After 2 weeks of organ culture, the neointimal proliferation was evaluated using histomorphometry. Pressure-related damage was compared with damage at baseline (0mmHg).RESULTSDuring routine competence testing for CABG, we revealed a median peak pressure of 355mmHg (range: 240639mmHg). In the experimental set-up, significant acute endothelial cell loss occurred at all tested distension pressures: at 50mmHg, the median endothelial cell loss was 29 (range: 2051, P0.015), at 100mmHg 54 (range: 3769, P<0.001), at 150mmHg 75 (range: 4188, P<0.001), at 300mmHg 91 (range: 63100, P<0.001) and at short high-pressure exposure 65 (range: 4982, P<0.001) in comparison with 20 (range: 044) at baseline. Significant neointimal proliferation occurred when a distension pressure of 50mmHg was exceeded: at 50mmHg, median neointimal proliferation was 97m (range: 60380m, P0.176), at 100mmHg 168m (range: 100600m, P0.001), at 150mmHg 183m (range: 160440m, P<0.001) at 300mmHg 347m (range: 190590m, P<0.001) and at short high-pressure exposure 130m (range: 60410m, P0.02) in comparison with 90m (range: 60170m) at baseline.CONCLUSIONSIn vitro exposure of SVGs to low distension pressure ranges causes significant acute endothelial cell loss and crucial long-term damage, namely neointimal proliferation.
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Oct 19, 2012
Keywords: Distension pressure Endothelial cell loss Neointimal proliferation Saphenous vein grafts
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