Chronic ultrastructural effects of temporary intraluminal shunts in a porcine off-pump model.
BACKGROUND
Temporary intraluminal shunts (TILS) are routinely used in off-pump revascularization to facilitate the anastomosis while maintaining myocardial blood supply. Whereas tourniquet-occlusion can cause vessel wall trauma, potentially adverse chronic effects of TILS on the coronary intima have not been evaluated yet. This chronic large animal study investigated ultrastructural effects of TILS on the vessel wall.


METHODS
Four groups of acute and chronic pigs with either tourniquet-occlusion (TOUR) or TILS (40 kg; acute, n = 12; chronic, n = 20) were analyzed. Animals underwent median sternotomy, heparin (150 U/kg) administration, and left anterior descending coronary artery exposure. In groups with TOUR the left anterior descending coronary artery was temporarily occluded (10 minutes) with a tourniquet. In groups with TILS a silicone shunt (1.5 mm diameter, 12 mm length) was placed in the left anterior descending coronary artery more than 10 minutes and then removed, and the insertion was repaired. Thirty minutes after reperfusion all acute animals were sacrificed whereas chronic animals were extubated, maintained for 3 months, and then sacrificed. The left anterior descending coronary artery regions of occlusion or placement of the TILS silicone bulbs were examined histopathologically by scanning and transmission electron microscopy by a blinded pathologist.


RESULTS
In both acute and chronic investigations animals in the TILS group exhibited significantly less morphologic damage than animals in the TOUR group. In the acute phase significantly more loss of cell junction (p = 0.037), loss of endothelium (p = 0.032), and intimal edema (p = 0.037) in the TOUR group than in the TILS group was observed. Three months later, characteristic features with a changed pattern were detected: vacuolization of the cell (p = 0.03), loss of cell junction (p = 0.042), and removal of basal membrane (p = 0.046) as well as extensive loss of endothelium (p = 0.003) in the TOUR group compared with the TILS group.


CONCLUSIONS
Intimal lesions occur with both maneuvers early and late. However, animals in the TOUR group exhibited injuries significantly more often and more severely. Therefore, acute and chronic intimal integrity of the coronary vessel may be better preserved using TILS and may thus have a positive impact on the extent of de novo stenosis and long-term prognosis of the revascularized region.
Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena-Lobeda, Germany. jens.wippermann@med.uni-jena.de
Jens
J
Wippermann
Johannes M
JM
Albes
Raimund
R
Bruhin
Martin
M
Hartrumpf
Rüdiger
R
Vollandt
Hartwig
H
Kosmehl
Thorsten
T
Wahlers
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D023903:Coronary Restenosis / Q000209:etiology; D023921:Coronary Stenosis / Q000209:etiology; D003331:Coronary Vessels / Q000293:injuries* / Q000648:ultrastructure; D007431:Intraoperative Complications / Q000517:prevention & control; D008854:Microscopy, Electron; D017202:Myocardial Ischemia / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology; D011897:Random Allocation; D034421:Sus scrofa; D014111:Tourniquets / Q000009:adverse effects; D017539:Tunica Intima / Q000293:injuries* / Q000648:ultrastructure