Document Detail


Disruption of graft endothelium correlates with early failure after off-pump coronary artery bypass surgery.
MedLine Citation:
PMID:  15919298     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Saphenous vein graft failure after coronary artery bypass surgery may be as high as 5% to 10% in the first postoperative week. We hypothesized that identifying damage sustained by saphenous vein endothelium before grafting predicts early graft attrition after off-pump coronary artery bypass graft surgery. METHODS: Intraoperative graft flow, platelet function, and endothelial integrity were analyzed in 125 patients undergoing off-pump coronary artery bypass graft surgery. Endothelial integrity was assessed in an excess vein segment from each graft using immunohistochemistry (CD31 staining). Platelet function was monitored just before and immediately after revascularization and on postoperative days 1 and 3 using whole blood aggregometry, thrombelastography, and platelet activated clotting time. Platelet activation was monitored using flow cytometry. Intraoperative conduit blood flow, measured by transit time ultrasonography, was used to detect and rectify anastomotic problems. Early graft patency was determined on postoperative day 5 using gated multichannel computed tomography angiography. RESULTS: In 106 patients undergoing postoperative computed tomography evaluation, 10 vein grafts in 10 patients were discovered to have developed early thrombosis, representing 4% (10 of 217) of all vein grafts. Endothelial integrity was 10.75% +/- 17.56% in 10 grafts that failed early compared with 51.45% +/- 36.29% in patent grafts (p = 0.04). Perioperative platelet function and graft flow did not differ significantly between the two groups. CONCLUSIONS: Although endothelial disruption predicts early failure of bypass grafts, the importance of a hypercoaguable state and low graft flow as a cause of early graft thrombosis after off-pump coronary artery bypass graft surgery was not supported by our preliminary results. A means to assess, prevent, and treat intraoperative vein graft damage will likely improve early graft patency.
Authors:
Jeffrey V Manchio; Junyan Gu; Linda Romar; James Brown; James Gammie; Richard N Pierson; Bartley Griffith; Robert S Poston
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  79     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-05-27     Completed Date:  2006-08-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1991-8     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / therapeutic use
Coronary Artery Bypass, Off-Pump / methods*
Coronary Artery Disease / surgery
Endothelium, Vascular / physiopathology*
Female
Heparin / therapeutic use
Humans
Male
Middle Aged
Platelet Activation
Postoperative Complications*
Risk Factors
Saphenous Vein / pathology*,  transplantation*
Thrombophilia
Thrombosis / etiology
Treatment Outcome
Vascular Patency
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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