title: Graft preservation solutions in cardiovascular surgery.
abstract: Vein grafts are still the most commonly used graft material in cardiovascular surgery and much effort has been spent in recent years on investigating the optimal harvesting technique. One other related topic of similar importance remained more or less an incidental one. The storage solutions of vein grafts following procurement and prior to implantation are, despite their assumed impact, a relatively neglected theme. There is no doubt that the endothelium plays a key role in long-term patency of vein grafts, but the effects of the different storage solutions on the endothelium remain unclear : In a review of the literature, we could find 20 specific papers that addressed the question, of which the currently available preservation solutions are superior, harmless, damaging or ineffective. The focus lies on saline and autologous whole blood. Besides these two storage media, novel or alternative solutions have been investigated with surprising findings. In addition, a few words will be spent on potential alternatives and novel solutions on the market. As there is currently no randomized clinical trial regarding saline versus autologous whole blood available, this review compares all previous studies and methods of analysis to provide a certain level of evidence on this topic. In summary, saline has negative effects on the endothelial layers and therefore may compromise graft patency. Related factors, such as distension pressure, may outbalance the initial benefit of autologous whole blood or storage solutions and intensify the harmful effects of warm saline. In addition, there is no uniform consent on the superiority of autologous whole blood for vein graft storage. This may open the door to alternatives such as the University of Wisconsin solution or one of the specific designed storage solutions like TiProtec™ or Somaluthion™. Whether these preservation solutions are superior or advantageous remains the subject of further studies.
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland bernhard.winkler@insel.ch.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Winkler
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Paul Philip
authors.initials: PP
authors.lastname: Heinisch
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Schönhoff
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Department of Cardiovascular Surgery, Inselspital, University of Berne, Berne, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
mesh_terms: D013504:Cardiovascular Surgical Procedures; D006801:Humans; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D016377:Organ Transplantation
chemical_list: D019188:Organ Preservation Solutions
keywords: Coronary artery bypass surgery; Saphenous vein graft; Storage solutions