Graft Preservation with heparinized blood/saline solution induces server graft dysfunction
Graft Preservation with heparinized blood/saline solution induces server graft dysfunction
As we have learned in class, coronary artery bypass grafting (CABG) is the most common surgical procedure performed on the heart and the patient’s prognosis largely depends on the long-term patency of the bypass grafts. In practice, grafts are stored at temperatures between 4 C and room temperature in various preservation solutions including saline, heparinized blood, or Custodial solution (Veres et al., 2014). According to Veres et al. (2014), heparinized autologous blood solutions is considered the most suitable solution for storing human arterial and venous grafts and samples, however there have been conflicting results on the effect of this solution on endothelial cells. This article looked at the early and mid-term effect of ischemia/reperfusion injury on endothelial cells of implanted grafts using a rat model of aortic transplantation. They examined the both the functional and molecular aspects of endothelial dysfunction induced.
A major finding of this study was that application of the daily used physiological saline or heparinized blood to preserve the arterial graft was incapable of reducing the endothelial damage after cold storage and warm reperfusion (Veres et al, 2014). They also concluded that both had similar weak preservation effect on the endothelial cells, however blood preservation solutions had a negative impact on these cells as compared to normal saline solution.
The peak of endothelial damage in both heparinized and saline groups occurred after twenty-four hours of reperfusion. This is said to correlate with the early complications in bypass grafts that lead to transient ST segment elevations occurring in the first 12-24 hours after CABG (Veres et al., 2014). Additionally this study found that endothelial integrity was damaged however it took the cells sample about one week of reperfusion to recover supporting previous findings of the ability of endothelial cells to regain functional integrity.
This study is important because the goal and current protocol for graft recovery is to minimize mechanical damaged during harvesting and this study demonstrates that both saline and heparinized blood solutions are incapable of this function as previously believed.
Veres, G., Hegedus, P., Barnucz, E., Zoller, R., Klien, S., Radovits, T., Korkmax, S., Karck, M. & Szabo, G. (2014). Graft Preservation with heparinized blood/saline solution induces server graft dysfunction. Interactive CardioVasular and Thorasic Surgery. 1-7. doi:10.1093/icvts/ivv010.
