Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması

Abstract

Amaç: Koroner arter grefti olarak kullanılan safen venin hazırlanmasında farklı cerrahi toplama teknikleri kullanılmaktadır. Bu çalışmanın amacı koroner arter baypas greftlemesi (KABG) için kullanılan safen ven hazırlama işlemlerinden geleneksel yöntem ile “no-touch” tekniği arasında apoptotik indeks açısından farklılığı araştırmaktır.

Gereç ve Yöntemler: KABG uygulanan 40 hastada geleneksel ve “no-touch” cerrahi yöntemleri kullanılarak toplanan safen venlerde apopitoz bakılarak prospektif, randomize bir klinik çalışma yapıldı. Toplanan safen ven parçaları paraformaldehitte bekletilerek tespit edildi. Kriyo cihazı ile 5 mikrometre kalınlığında kesitler alındı. Örnekler modifiye TUNEL yöntemi ile işaretlenerek apopitotik hücre ölümleri gösterildi. Doku kesitlerindeki TUNEL (+) ve (-) hücreler Stereo Investigator version 7.5 görüntü işleme yazılımı kullanılarak tarafsız ve eşit 100 çerçeveye optik olarak bölünmüş alanlarda sayıldı. Apoptotik indeks; Hücre / Toplam Hücre oranı kullanılarak hesaplandı. Sonuçlar bağımsız gruplarda t testi ile istatistiksel olarak değerlendirildi.

Bulgular: Geleneksel yöntem ile “no-touch” tekniği apoptotik indeksleri karşılaştırıldı. Geleneksel tekniğin uygulandığı grubunun apoptotik indeksi “no-touch” tekniği uygulanan diğer gruba göre anlamlı oranda yüksek bulundu. Mekanik ve yapısal koruma venin etrafını kuşatan yastıkçıklar tarafından sağlanmaktadır. Bu yastıkçıklarda apoptotik hücre ölümünün daha az görülmesi safen vendeki doku hasarının daha az olduğunu gösterir.

Sonuç: Safen ven grefti hazırlamasında geleneksel yöntem yerine ‘no-touch’ cerrahi tekniğinin tercih edilmesi ile doku hasarı ve vazospazm oluşumunun azalabileceği ve baypas sonrası greftin açık kalma olasılığının artabileceği sonucuna ulaşıldı.

Keywords

• Safen ven,koroner damar baypas,apopitoz

Apoptotic Index of the Saphenous Vein Using Different Harvesting Methods for a Coronary Artery Bypass Graft

Abstract

Aim: Different surgical harvesting techniques are applied to prepare the saphenous vein which is used as a coronary artery graft. The aim of this study is to investigate two different surgical techniques, the conventional and no-touch, which are used in coronary artery bypass grafting (CABG), in the preparation for saphenous vein by comparing the apoptotic index results.

Material and Methods: A prospective, randomized clinical study comparing 2 different saphenous vein harvesting techniques, the conventional and no-touch methods, was performed with 40 patients who underwent CABG. Small pieces of the SV tissues were fixed for paraformaldehyde. Up to 5 - µm - thick cryosections were obtained with a cryostat. Samples have labeled with modified TUNEL method and apoptotic cell deaths were shown. TUNEL (+) and (-) cells were determined in tissue sections and counted in unbiased and equal 100 frames optically divided areas by using the Stereo Investigator version 7.5 image analysis software. The apoptotic index was calculated as the ratio of apoptotic cells/total cells. Findings were statistically analyzed by using the independent sample t test.

Results: The apoptotic index of the conventional method and the no-touch surgical technique were compared. The conventional technique apoptotic index results were significantly higher than that no-touch technique group. Mechanical and structural protection is provided by the cushions surrounding the vein. Less apoptotic cell death in these cushions means less tissue damage in the saphenous vein. The fact that the cushions which provide venous, mechanical and structural support are more stable shows that apoptotic cell death in the 'no-touch' technique group is less than the other groups.

Conclusion: It was concluded that, in saphenous vein graft preparation, preferring the “no-touch” surgical technique instead of conventional method could decrease tissue injury and vasospasm and the possibility of the graft to remain open after bypass could increase.

Keywords

• Saphaneous vein,apoptosis,coronary artery bypass

References

1. 1. Raja SG, Haider Z, Ahmad M, Zaman H. Saphenous vein grafts: to use or not to use? Heart Lung Circ. 2004; 13(4): 403-9.
2. 2. Fulton GJ, Davies MG, Hagen PO. Preservation of the endothelium in venous bypass grafts: relevance for graft patency. Asia-Pacific Heart J. 1997; 6(2): 98-106.
3. 3. Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in situ autogenous vein grafts. Ann. Surg. 1985; 202(1): 50-5.
4. 4. Angelini GD, Bryan AJ, Williams HM, Morgan R, Newby AC. Distention promotes platelet and leukocyte adhesion and reduces short-term patency in pig arteriovenous bypass grafts. J Thorac Cardiovasc Surg. 1999; 99(3): 433-9.
5. 5. Boerboom LE, Bonchek LI, Kissebah AH, Werner PH, Pepper JR, Olinger GN, et al. Effect of surgical trauma on tissue lipids in primate vein grafts: relation to plasma lipids. Circulation. 1980; 62(2 Pt 2): I142-7.
6. 6. Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001; 72(6): 2245-52.
7. 7. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Declercq SC, van Cauwelaert PA, et al. Foam cell replication and smooth muscle cell apoptosis in human saphenous vein grafts. Histopathology. 1994; 25(4): 365-71.
8. 8. Urbanek T, Skop B, Wiaderkiewicz R, Wilczok T, Ziaja K, Lebda-Wyborny T, et al. Smooth muscle cell apoptosis in primary varicose veins. Eur J Vasc Endovasc Surg. 2004; 28(6): 600-11.

9. 9. Lucassen PJ, Chung WCJ, Vermeulen JP, van Lookeren Campagne M, van Dierendonck aJH, Swaab DF. Microwave-enhanced in situ end-labeling of fragmented DNA:parametric studies in relation to postmortem delay and fixation of rat and human brain. J Histochem Cytochem. 1995; 43(11): 1163-71.
10. 10. Yildirim A, Ersoy Y, Ercan F, Atukeren P, Gumustas K, Uslu U, et al. Phosphodiesterase-5 inhibition by sildenafil citrate in a rat modelof bleomycin-induced lung fibrosis. Pulm Pharmacol Ther. 2010; 23(3): 215-21.
11. 11. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Van Cauwelaert PA. The modulation of smooth muscle cell phenotype is an early event in human aorta-coronary saphenous vein grafts. Virchows Arch A Pathol Anat Histopathol. 1992; 420(2): 155-62.
12. 12. Karayannacos PE, Rittgers E, Kakos GS, Williams TE Jr, Meckstroth CV, Vasko JS. Potential role of velocity and wall tension in vein graft failure. J Cardiovasc Surg. 1980; 21(2): 171-8.
13. 13. Rueda F, Souza D, Lima Rde C, Menezes A, Johansson B, Dashwood B, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol. 2008; 90(6): 356-62.
14. 14. Ramos JR, Berger K, Mansfield PB, Sauvage LR. Histologic fate and endothelial changes of distended and nondistended vein grafts. Ann Surg. 1976; 183(3): 205-28.
15. 15. He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993; 55(5):1210-7.
16. 16. Dündar S, Özcura F, Meteoğlu İ, Kara ME. Effects of long-term passive smoking on the vascular endothelial growth factor and apoptosis marker expression in the retina and choroid: an experimental study. Turk J Med Sci. 2012; 42(3): 377-83.
17. 17. Ashkenazi A, Dixit VM. Death receptors: signaling and modulation. Science. 1998; 281(5381): 1305-8.
18. 18. Polat A, Kayaselçuk F, Eğilmez R, Tuncer İ. Expression of Fas Antigen and Bcl-2 Protein in Liver Tissues of Patients with Chronic Hepatitis B. Turk J Med Sci. 2001; 31(6): 517-21.
19. 19. Goping IS, Gross A, Lavoie JN, Nguyen M, Jemmerson R, Roth K, et al. Regulated targeting of BAX to mitochondria. J Cell Biol. 1998; 143(1): 207-15.
20. 20. Griffiths GJ, Dubrez L, Morgan CP, Jones NA, Whitehouse J, Corfe BM, et al. Cell damage-induced conformational changes of the pro-apoptotic protein Bak in vivo precede the onset of apoptosis. J Cell Biol. 1999; 144(5): 903-14.
21. 21. Gottlieb RA, Gruol DL, Zhu JY, Engler RL. Preconditioning rabbit cardiomyocytes: role of pH, vacuolar proton ATPase and apoptosis. J Clin Invest. 1996; 97(10): 2391-8.
22. 22. Kiliçkan L, Gonca S, Dalçik C, Dalçik H, Solak M, Bayindir O, et al. General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2. J Cardiovasc Surg. 2006; 47(3): 315-22.
23. 23. Golledge J. Vein grafts: haemodynamic forces on the endotheliuma review. Eur J Vasc Endovasc Surg. 1997; 14(4): 333-43.
24. 24. Souza DS, Christofferson RH, Bomfim V, Filbey D. “No-touch” technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium. Scand Cardiovasc J. 1999; 33(6): 323-9.