Journal Article

Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation

Yukio Okazaki, Kyomi Takarabe, Jun-ichi Murayama, Etsuro Suenaga, Kojiro Furukawa, Kazuhisa Rikitake, Masafumi Natsuaki and Tsuyoshi Itoh

in European Journal of Cardio-Thoracic Surgery

Published on behalf of European Association for Cardio-Thoracic Surgery

Volume 19, issue 6, pages 834-839
Published in print June 2001 | ISSN: 1010-7940
Published online June 2001 | e-ISSN: 1873-734X | DOI: http://dx.doi.org/10.1016/S1010-7940(01)00708-4
Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation

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Objective: Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects of coronary snaring with looped sutures and gas insufflation on the coronary endothelium. The protective efficacies on the coronary endothelium of coronary snaring with elastic sutures or humidified gas insufflation with/without heparin and dipyridamole-added were also tested. Methods: Thirty-six mongrel dogs were used. After systemic heparinization (150 U/kg), a 5 mm longitudinal coronary incision was made with looped non-elastic monofilament sutures or elastic sutures applied proximally and distally. The incised coronary artery was exposed to non-humidified carbon dioxide, humidified carbon dioxide with lactated Ringer solution, or humidified carbon dioxide with heparin and dipyridamole-added lactated Ringer solution for 10 or 20 min in each group. After gas insufflation, the incised coronary artery was repaired, then, the coronary was reperfused. Perfusion-fixation was done for observation of the coronary endothelium by scanning electron microscopy. The adverse effect on the endothelium was graded as follows: grade 1, appeared normal; grade 2, few blood cells deposited; grade 3, many blood cells deposited; grade 4, few endothelial cells delaminated with blood cells deposited; grade 5, many endothelial cells delaminated with blood cells deposited. Results: Non-elastic looping caused much more endothelial tears than elastic looping (P≪0.00001). Non-humidified gas blowing for 20 min caused more endothelial cell damage than humidified gas blowing (P=0.00005). Non-humidified gas blowing for 10 min caused less damage than for 20 min (P=0.00326), but still caused more damage than humidified gas blowing (P=0.00253). Heparin and dipyridamole-added humidification reduced coronary endothelial area mottled by the deposited cells when compared with simple humidification (P=0.00120). Conclusions: Coronary snaring resulted in coronary endothelial injury, which was ameliorated by using elastic sutures instead of non-elastic sutures. Non-humidified gas insufflation made blood cells deposited and endothelial cells delaminated with time. Humidified gas insufflation attenuated these adverse effects. Heparin and dipyridamole-added humidification had potential advantage in terms of reducing deposited blood cells on the endothelium over simple humidification.

Keywords: Off-pump coronary artery bypass grafting; Coronary endothelial injury; Less invasive cardiac surgery

Journal Article.  3056 words.  Illustrated.

Subjects: Cardiovascular Medicine ; Cardiothoracic Surgery

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