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

Yıl 2020, Cilt: 10 Sayı: 2, 145 - 149, 31.05.2020

Ünal Uslu Süheyla Gonca Alev Cumbul Onur Sen

https://doi.org/10.33631/duzcesbed.662453

Öz

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.

Anahtar Kelimeler

Safen ven, koroner damar baypas, apopitoz

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

Öz

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.

Anahtar Kelimeler

Saphaneous vein, apoptosis, coronary artery bypass

Kaynakça

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