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. 2018 Jul;10(7):4302-4310.
doi: 10.21037/jtd.2018.06.91.

Antegrade cardioplegia as a possible cause of acute saphenous vein endothelial damage in patients undergoing on pump coronary artery bypass surgery

Ioannis Koukis  1 , Stavros Siminelakis  2 , Michalis Argiriou  3 , Nikolaos Theakos  3 , Anna Takou  4 , George Pounis  1 , Christos Charitos  3 , Efstratios Apostolakis  2
Affiliations

Antegrade cardioplegia as a possible cause of acute saphenous vein endothelial damage in patients undergoing on pump coronary artery bypass surgery

Ioannis Koukis et al. J Thorac Dis. 2018 Jul.

Abstract

Background: The administration of antegrade cardioplegia through vein grafts after the completion of each distal anastomosis is a common practice. However, the cardioplegic solution may disrupt the vein endothelium and contribute to late vein graft atherosclerotic disease. This study aimed at evaluating the possible impact of the cardioplegic solution on vein graft endothelium.

Methods: Total of 52 patients (16 women and 36 men) aged 68±8.5 years old that underwent on pump coronary revascularization with at least one vein graft were enrolled. Sections of grafts from the greater saphenous vein were obtained prior to and after delivery of potassium antegrade cardioplegic solution through them. These sections were then examined histologically with immunochemical stain and CD34 index. The endothelial damage and length of vein specimens of both graft sections were evaluated.

Results: The endothelial damage of vein specimens appeared to be increased significantly with exposure to antegrade cardioplegia in male and female patients (P from Wilcoxon tests <0.001, for both genders). The increase in the length of vein specimens was significant too (P from Wilcoxon test <0.001 for men and P=0.001 for women).

Conclusions: Antegrade cardioplegia delivered through vein grafts causes substantial damage on vein endothelium. This may have an adverse effect on long-term graft patency.

Keywords: Antegrade cardioplegia; CD34; coronary artery bypass grafting (CABG); endothelial damage; vein graft.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Antegrade cardioplegia and acute vein endothelial damage. The comparisons of endothelial injury before and after the antegrade cardioplegia for both genders were performed using the non-parametric Wilcoxon test.
Figure 2
Figure 2
Antegrade cardioplegia and length of vein specimens. The comparisons of the length of vein specimens with and without the antegrade cardioplegia for both genders were performed using the non-parametric Wilcoxon test.
Figure 3
Figure 3
IHC staining with CD34. The endothelium shows a linear positive nuclear and cytoplasmic staining (group A; ×20).
Figure 4
Figure 4
Extensive loss of endothelial cells in a case of group B as it seems in negative immunostaining with CD34 (×20).
See this image and copyright information in PMC

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