Continuous graft perfusion: optimizing the quality of saphenous vein grafts.
BACKGROUND
Healthy unaltered vascular endothelium in graft material is a prerequisite for a successful CABG operation. Damage done to the endothelium during vein harvest is responsible for an early graft occlusion rate of 20% in the first year after operation. Minimally invasive vein harvesting is regarded to minimize the damage done to the Endothelium. We compared minimally invasive vein harvesting with conventional vein harvesting and studied the influence of a continuous perfusion of the veins with patient autologous blood on their endothelial integrity.


METHODS
80 patients were randomly split into 4 groups: Group 1: Conventional vein harvest and storage of the vein in a crystalloid solution before usage. Group 2: Endoscopic vein harvest and storage in cristallloid solution. Group 3: Conventional harvest under continuous perfusion of the vein with 100 ml blood via the heart lung machine. Group 4: Endoscopic vein harvest under continuous perfusion. Immediately prior to the first peripheral anastomosis a sample was taken from each graft and evaluated by scanning electron microscopy. The endothelial integrity was rated in 5 categories (from "completely confluent endothelium" (1) to "no endothelium" (5)).


RESULTS
Group 1: 2.7+/-1.13 Group 2: 2.2+/-1.06 Group 3: 1.6+/-0.68 Group 4: 1.6+/-0.69


CONCLUSIONS
In regard to the endothelial integrity endoscopic vein harvesting is superior to conventional vein harvest. If the grafts are harvested while continuously perfused with blood there is no more difference between the groups. Considering the well known additional benefits such as reduction in wound healing disorders endoscopic vein harvesting appears to be the preferable technique.
Lamm
P
P
Department of Cardiac Surgery, Ludwig-Maximilians-Universit.t Munchen, Munich, Germany. lamm@lrz.uni-muenchen.de
Juchem
G
G
Milz
S
S
Reichart
B
B
D017546:Angioscopy; D001769:Blood; D001026:Coronary Artery Bypass / Q000379:methods* / Q000592:standards; D004730:Endothelium, Vascular / Q000293:injuries / Q000502:physiology*; D005947:Glucose; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008353:Mannitol; D019188:Organ Preservation Solutions; D010477:Perfusion / Q000379:methods; D011189:Potassium Chloride; D011343:Procaine; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000502:physiology / Q000637:transplantation*; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000592:standards
C039984:Bretschneider cardioplegic solution; D019188:Organ Preservation Solutions; D008353:Mannitol; D011343:Procaine; D011189:Potassium Chloride; D005947:Glucose