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Lian S, Loganathan S, Mayer T, Kraft P, Sayour AA, Georgevici AI, Veres G, Karck M, Szabó G, Korkmaz-Icöz S. In a rat model of bypass DuraGraft ameliorates endothelial dysfunction of arterial grafts. Sci Rep 2024; 14:15174. [PMID: 38956161 PMCID: PMC11220020 DOI: 10.1038/s41598-024-66056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
Coronary artery bypass surgery can result in endothelial dysfunction due to ischemia/reperfusion (IR) injury. Previous studies have demonstrated that DuraGraft helps maintain endothelial integrity of saphenous vein grafts during ischemic conditions. In this study, we investigated the potential of DuraGraft to mitigate endothelial dysfunction in arterial grafts after IR injury using an aortic transplantation model. Lewis rats (n = 7-9/group) were divided in three groups. Aortic arches from the control group were prepared and rings were immediately placed in organ baths, while the aortic arches of IR and IR + DuraGraft rats were preserved in saline or DuraGraft, respectively, for 1 h before being transplanted heterotopically. After 1 h after reperfusion, the grafts were explanted, rings were prepared, and mounted in organ baths. Our results demonstrated that the maximum endothelium-dependent vasorelaxation to acetylcholine was significantly impaired in the IR group compared to the control group, but DuraGraft improved it (control: 89 ± 2%; IR: 24 ± 1%; IR + DuraGraft: 48 ± 1%, p < 0.05). Immunohistochemical analysis revealed decreased intercellular adhesion molecule-1, 4-hydroxy-2-nonenal, caspase-3 and caspase-8 expression, while endothelial cell adhesion molecule-1 immunoreactivity was increased in the IR + DuraGraft grafts compared to the IR-group. DuraGraft mitigates endothelial dysfunction following IR injury in a rat bypass model. Its protective effect may be attributed, at least in part, to its ability to reduce the inflammatory response, oxidative stress, and apoptosis.
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Affiliation(s)
- Shuo Lian
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
| | - Sivakkanan Loganathan
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120, Halle, Germany
| | - Tobias Mayer
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
| | - Patricia Kraft
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
| | - Alex Ali Sayour
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
- Heart and Vascular Center, Semmelweis University, Budapest, 1122, Hungary
| | - Adrian-Iustin Georgevici
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120, Halle, Germany
- Department of Anesthesiology, St. Josef Hospital, Ruhr-University Bochum, 44791, Bochum, Germany
| | - Gábor Veres
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120, Halle, Germany
| | - Matthias Karck
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
| | - Gábor Szabó
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120, Halle, Germany
| | - Sevil Korkmaz-Icöz
- Laboratory of Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, INF 326, 69120, Heidelberg, Germany.
- Department of Cardiac Surgery, University Hospital Halle (Saale), 06120, Halle, Germany.
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2
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Misfeld M, Sandner S, Caliskan E, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Adsuar-Gomez A, Thielmann M, Serraino GF, Doros G, Borger MA, Emmert MY. Outcomes after surgical revascularization in diabetic patients. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae014. [PMID: 38218725 PMCID: PMC10850843 DOI: 10.1093/icvts/ivae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVES Patients with diabetes mellitus (DM) undergoing coronary artery bypass grafting (CABG) have been repeatedly demonstrated to have worse clinical outcomes compared to patients without DM. The objective of this study was to evaluate the impact of DM on 1-year clinical outcomes after isolated CABG. METHODS The European DuraGraft registry included 1130 patients (44.6%) with and 1402 (55.4%) patients without DM undergoing isolated CABG. Intra-operatively, all free venous and arterial grafts were treated with an endothelial damage inhibitor. Primary end point in this analysis was the incidence of a major adverse cardiac event (MACE), a composite of all-cause death, repeat revascularization or myocardial infarction at 1 year post-CABG. To balance between differences in baseline characteristics (n = 1072 patients in each group), propensity score matching was used. Multivariable Cox proportional hazards regression was performed to identify independent predictors of MACE. RESULTS Diabetic patients had a higher cardiovascular risk profile and EuroSCORE II with overall more comorbidities. Patients were comparable in regard to surgical techniques and completeness of revascularization. At 1 year, diabetics had a higher MACE rate {7.9% vs 5.5%, hazard ratio (HR) 1.43 [95% confidence interval (CI) 1.05-1.95], P = 0.02}, driven by increased rates of death [5.6% vs 3.5%, HR 1.61 (95% CI 1.10-2.36), P = 0.01] and myocardial infarction [2.8% vs 1.4%, HR 1.99 (95% CI 1.12-3.53) P = 0.02]. Following propensity matching, no statistically significant difference was found for MACE [7.1% vs 5.7%, HR 1.23 (95% CI 0.87-1.74) P = 0.23] or its components. Age, critical operative state, extracardiac arteriopathy, ejection fraction ≤50% and left main disease but not DM were identified as independent predictors for MACE. CONCLUSIONS In this study, 1-year outcomes in diabetics undergoing isolated CABG were comparable to patients without DM.
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Affiliation(s)
- Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
- Medical School, University of Sydney, Sydney, Australia
| | - Sigrid Sandner
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Etem Caliskan
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, Medical Faculty, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat, Turkey
- Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | | | | | | | | | - Matthias Thielmann
- West-German Heart and Vascular Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Maximilian Y Emmert
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
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3
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Huber C. Endothelial dysfunction of venous graft a thing of the past? Dedicated storage solutions with endothelial damage inhibitor properties might increase venous graft performance. Eur J Cardiothorac Surg 2023; 64:ezad377. [PMID: 38036462 DOI: 10.1093/ejcts/ezad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/29/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Christoph Huber
- Division of Cardiovascular Surgery, University Hospital Geneva and Medical Faculty of the University of Geneva, Geneva, Switzerland
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4
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Nazari-Shafti TZ, Thau H, Zacharova E, Beez CM, Exarchos V, Neuber S, Meyborg H, Puhl K, Wittig C, Szulcek R, Neumann K, Giampietro C, Krüger K, Cesarovic N, Falk V, Caliskan E, Rodriguez Cetina Biefer H, Emmert MY. Endothelial damage inhibitor preserves the integrity of venous endothelial cells from patients undergoing coronary bypass surgery. Eur J Cardiothorac Surg 2023; 64:ezad327. [PMID: 37740952 DOI: 10.1093/ejcts/ezad327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/04/2023] [Accepted: 09/22/2023] [Indexed: 09/25/2023] Open
Abstract
OBJECTIVES Despite the success of coronary artery bypass graft (CABG) surgery using autologous saphenous vein grafts (SVGs), nearly 50% of patients experience vein graft disease within 10 years of surgery. One contributing factor to early vein graft disease is endothelial damage during short-term storage of SVGs in inappropriate solutions. Our aim was to evaluate the effects of a novel endothelial damage inhibitor (EDI) on SVGs from patients undergoing elective CABG surgery and on venous endothelial cells (VECs) derived from these SVGs. METHODS SVGs from 11 patients participating in an ongoing clinical registry (NCT02922088) were included in this study, and incubated with both full electrolyte solution (FES) or EDI for 1 h and then examined histologically. In 8 of 11 patients, VECs were isolated from untreated grafts, incubated with both FES and EDI for 2 h under hypothermic stress conditions and then analysed for activation of an inflammatory phenotype, cell damage and cytotoxicity, as well as endothelial integrity and barrier function. RESULTS The EDI was superior to FES in protecting the endothelium in SVGs (74 ± 8% versus 56 ± 8%, P < 0.001). Besides confirming that the EDI prevents apoptosis in SVG-derived VECs, we also showed that the EDI temporarily reduces adherens junctions in VECs while protecting focal adhesions compared to FES. CONCLUSIONS The EDI protects the connectivity and function of the SVG endothelium. Our data suggest that the EDI can preserve focal adhesions in VECs during short-term storage after graft harvesting. This might explain the superiority of the EDI in maintaining most of the endothelium in venous CABG surgery conduits.
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Affiliation(s)
- Timo Z Nazari-Shafti
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Henriette Thau
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Ema Zacharova
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Department of Life Sciences, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
| | - Christien M Beez
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Vasileios Exarchos
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Sebastian Neuber
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Heike Meyborg
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Kerstin Puhl
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Corey Wittig
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Laboratory for in vitro modeling systems of pulmonary and thrombotic diseases, Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Szulcek
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Laboratory for in vitro modeling systems of pulmonary and thrombotic diseases, Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Costanza Giampietro
- Experimental Continuum Mechanics, Empa Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - Katrin Krüger
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Etem Caliskan
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiac Surgery, City Hospital of Zurich, Site Triemli, Zurich, Switzerland
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Institute for Regenerative Medicine, University of Zurich, Zurich, Switzerland
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5
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Sandner S, Misfeld M, Caliskan E, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Doros G, Vitarello CJ, Emmert MY. Clinical outcomes and quality of life after contemporary isolated coronary bypass grafting: a prospective cohort study. Int J Surg 2023; 109:707-715. [PMID: 36912566 PMCID: PMC10389413 DOI: 10.1097/js9.0000000000000259] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The objective of the European Multicenter Registry to Assess Outcomes in coronary artery bypass grafting (CABG) patients (DuraGraft Registry) was to determine clinical outcomes and quality of life (QoL) after contemporary CABG that included isolated CABG and combined CABG/valve procedures, using an endothelial damage inhibitor (DuraGraft) intraoperatively for conduit preservation. Here, we report outcomes in the patient cohort undergoing isolated CABG. METHODS The primary outcome was the composite of all-cause death, myocardial infarction (MI), or repeat revascularization (RR) [major adverse cardiac events (MACE)] at 1 year. Secondary outcomes included the composite of all-cause death, MI, RR, or stroke [major adverse cardiac and cerebrovascular events (MACCE)], and QoL. QoL was assessed with the EuroQol-5 Dimension questionnaire. Independent risk factors for MACE at 1 year were determined using Cox regression analysis. RESULTS A total of 2532 patients (mean age, 67.4±9.2 years; 82.5% male) underwent isolated CABG. The median EuroScore II was 1.4 [interquartile range (IQR), 0.9-2.3]. MACE and MACCE rates at 1 year were 6.6% and 7.8%, respectively. The rates of all-cause death, MI, RR, and stroke were 4.4, 2.0, 2.2, and 1.9%, respectively. The 30-day mortality rate was 2.3%. Age, extracardiac arteriopathy, left ventricular ejection fraction less than 50%, critical operative state, and left main disease were independent risk factors for MACE. QoL index values improved from 0.84 [IQR, 0.72-0.92] at baseline to 0.92 [IQR, 0.82-1.00] at 1 year ( P <0.0001). CONCLUSION Contemporary European patients undergoing isolated CABG have a low 1-year clinical event rate and an improved QoL.
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Affiliation(s)
| | - Martin Misfeld
- Royal Prince Alfred Hospital
- Institute of Academic Surgery at Royal Prince Alfred Hospital
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney
- Medical School, University of Sydney, Camperdown, New South Wales, Australia
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig
| | - Etem Caliskan
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
| | | | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen, Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat
- Bahçeşehir University Faculty of Medicine, Istanbul, Turkey
| | | | | | | | | | - Markus Krane
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | | | - Maximilian Y. Emmert
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
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Szalkiewicz P, Emmert MY, Heinisch PP, Arnold Z, Crailsheim I, Mach M, Aschacher T, Grabenwöger M, Winkler B. Graft preservation confers myocardial protection during coronary artery bypass grafting. Front Cardiovasc Med 2022; 9:922357. [PMID: 35966546 PMCID: PMC9365949 DOI: 10.3389/fcvm.2022.922357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background During on-pump coronary artery bypass grafting (ONCAB), graft flushing for distal anastomoses testing also perfuses the downstream myocardium. This single-center retrospective study evaluated the impact of specific preservation solutions on myocardial protection during ONCAB. Materials and methods Between July 2019 and March 2020 either DuraGraft (DG) or 0.9% Saline/Biseko (SB) was applied to 272 ONCAB. Overall, 166 patients were propensity-matched into two groups. Cardiac enzymes [high-sensitive Troponin I (hs-TnI) and creatine kinase (CK)] were evaluated 7 days post-surgery. Results Post-surgery, hs-TnI values were significantly lower from 3 to 6 h (h) up to 4 days in the DG group: 3–6 h: 4,034 ng/L [IQR 1,853–8,654] vs. 5,532 ng/L [IQR 3,633—8,862], p = 0.05; 12–24 h: 2,420 ng/L [IQR 1,408–5,782] vs. 4,166 [IQR 2,052–8,624], p < 0.01; 2 days: 1,095 ng/L [IQR 479–2,311] vs. 1,564 ng/L [IQR 659–5,057], p = 0.02 and at 4 days: 488 ng/L [IQR 232–1,061] vs. 745 ng/L [IQR 319–1,820], p = 0.03. The maximum value: 4,151 ng/L [IQR 2,056–8,621] vs. 6,349 ng/L [IQR 4,061–12,664], p < 0.01 and the median area under the curve (AUC): 6,146 ng/L/24 h [IQR 3,121–13,248] vs. 10,735 ng/L/24 h [IQR 4,859–21,484], p = 0.02 were lower in the DG group. CK values were not significantly different between groups: maximum value 690 [IQR 417–947] vs. 631 [464–979], p = 0.61 and AUC 1,986 [1,226–2,899] vs. 2,081 [1,311–3,063], p = 0.37. Conclusion Repeated graft flushing with DG resulted in lower Troponin values post-surgery suggesting enhanced myocardial protection compared to SB. Additional studies are warranted to further assess the myocardial protection properties of DG.
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Affiliation(s)
- Philipp Szalkiewicz
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
| | - Maximilian Y. Emmert
- Deutsches Herzzentrum Berlin, Berlin, Germany
- Clinic for Cardiovascular Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Paul P. Heinisch
- German Heart Centre Munich, Technical University Munich, Munich, Germany
| | - Zsuzsanna Arnold
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
- Vienna Health Association, Vienna, Austria
| | - Ingo Crailsheim
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
- Vienna Health Association, Vienna, Austria
| | - Markus Mach
- Medical University of Vienna, Vienna, Austria
- Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Aschacher
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
- Vienna Health Association, Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Martin Grabenwöger
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
- Vienna Health Association, Vienna, Austria
- Sigmund Freud University Vienna, Vienna, Austria
| | - Bernhard Winkler
- Karl Landsteiner Institute for Cardiac and Vascular Surgical Research, Vienna, Austria
- Vienna Health Association, Vienna, Austria
- Medical University of Vienna, Vienna, Austria
- *Correspondence: Bernhard Winkler,
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Abstract
Cardiovascular defects, injuries, and degenerative diseases often require surgical intervention and the use of implantable replacement material and conduits. Traditional vascular grafts made of synthetic polymers, animal and cadaveric tissues, or autologous vasculature have been utilized for almost a century with well-characterized outcomes, leaving areas of unmet need for the patients in terms of durability and long-term patency, susceptibility to infection, immunogenicity associated with the risk of rejection, and inflammation and mechanical failure. Research to address these limitations is exploring avenues as diverse as gene therapy, cell therapy, cell reprogramming, and bioengineering of human tissue and replacement organs. Tissue-engineered vascular conduits, either with viable autologous cells or decellularized, are the forefront of technology in cardiovascular reconstruction and offer many benefits over traditional graft materials, particularly in the potential for the implanted material to be adopted and remodeled into host tissue and thus offer safer, more durable performance. This review discusses the key advances and future directions in the field of surgical vascular repair, replacement, and reconstruction, with a focus on the challenges and expected benefits of bioengineering human tissues and blood vessels.
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Affiliation(s)
- Kaleb M. Naegeli
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Mehmet H. Kural
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Yuling Li
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | - Juan Wang
- Humacyte, Inc, Durham, NC (K.M.N., M.H.K., Y.L., J.W., E.A.H., L.E.N.)
| | | | - Laura E. Niklason
- Department of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT (L.E.N.)
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Efficacy of Intraoperative Vein Graft Storage Solutions in Preserving Endothelial Cell Integrity during Coronary Artery Bypass Surgery. J Clin Med 2022; 11:jcm11041093. [PMID: 35207364 PMCID: PMC8877698 DOI: 10.3390/jcm11041093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Introduction: Intraoperative preservation solutions for saphenous vein grafts may influence the endothelial structure and increase the risk of graft failure after coronary surgery. The aim of the study was to compare the efficacy of three solutions in maintaining the endothelial cell integrity of venous segments. (2) Methods: We tested the efficacy of physiological saline solution (PSS), heparinized autologous blood (HAB) and DuraGraft® in preserving the endothelium of vein segments by evaluating the degree of endothelial cell apoptosis. Two incubation times (2 and 4 h from harvesting) were used for each solution. The quantification of apoptotic cells was computed as the intensity nuclei/intensity area ratio. (3) Results: After 2 h of ischemia, the degree of apoptosis decreased progressively across the use of DuraGraft, HAB and PSS (p = 0.004), although only the difference between DuraGraft and PSS yielded a statistical significance (p = 0.002). After 4 h, a similar decrease in apoptosis was shown across the three media; however, statistical significance was not reached. The analysis of the elapsed time (2 or 4 h of incubation) showed that this was a relevant factor in maintaining the endothelial structural integrity independently from the storage solution (test for interaction of media and time p = 0.010). (4) Conclusion: Within 2 h of incubation, endothelial structural integrity depended on the incubating medium. DuraGraft better protected the SVG against ischemic-induced apoptosis when compared to saline solution. Prolonged ischemia was associated with extended endothelium damage and none of the studied solutions protected the vein graft.
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Aspirin Reduces Ischemia-Reperfusion Injury Induced Endothelial Cell Damage of Arterial Grafts in a Rodent Model. Antioxidants (Basel) 2022; 11:antiox11020177. [PMID: 35204060 PMCID: PMC8868254 DOI: 10.3390/antiox11020177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 12/10/2022] Open
Abstract
Long-term graft patency determines the prognosis of revascularization after coronary artery bypass grafting (CABG). Ischemia-reperfusion (I/R) injury of the graft suffered during harvesting and after implantation might influence graft patency. Aspirin, a nonsteroidal anti-inflammatory drug improves the long-term patency of vein grafts. Whether aspirin has the same effect on arterial grafts is questionable. We aimed to characterize the beneficial effects of aspirin on arterial bypass grafts in a rodent revascularization model. We gave Lewis rats oral pretreatment of either aspirin (n = 8) or saline (n = 8) for 5 days, then aortic arches were explanted and stored in cold preservation solution. The third group (n = 8) was a non-ischemia-reperfusion control. Afterwards the aortic arches were implanted into the abdominal aorta of recipient rats followed by 2 h of reperfusion. Endothelium-dependent vasorelaxation was examined with organ bath experiments. Immunohistochemical staining were carried out. Endothelium-dependent maximal vasorelaxation improved, nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the aspirin preconditioned group, compared to the transplanted control group. Significantly improved endothelial function and reduced I/R injury induced structural damage were observed in free arterial grafts after oral administration of aspirin. Aspirin preconditioning before elective CABG might be beneficial on free arterial graft patency.
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Aschacher T, Baranyi U, Aschacher O, Eichmair E, Messner B, Zimpfer D, Moayedifar R, Laufer G, Emmert MY, Sandner SE. A Novel Endothelial Damage Inhibitor Reduces Oxidative Stress and Improves Cellular Integrity in Radial Artery Grafts for Coronary Artery Bypass. Front Cardiovasc Med 2021; 8:736503. [PMID: 34692789 PMCID: PMC8527012 DOI: 10.3389/fcvm.2021.736503] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
The radial artery (RA) is a frequently used conduit in coronary artery bypass grafting (CABG). Endothelial injury incurred during graft harvesting promotes oxidative damage, which leads to graft disease and graft failure. We evaluated the protective effect of DuraGraft®, an endothelial damage inhibitor (EDI), on RA grafts. We further compared the protective effect of the EDI between RA grafts and saphenous vein grafts (SVG). Samples of RA (n = 10) and SVG (n = 13) from 23 patients undergoing CABG were flushed and preserved with either EDI or heparinized Ringer's lactate solution (RL). The effect of EDI vs. RL on endothelial damage was evaluated ex vivo and in vitro using histological analysis, immunofluorescence staining, Western blot, and scanning electron microscopy. EDI-treated RA grafts showed a significant reduction of endothelial and sub-endothelial damage. Lower level of reactive oxygen species (ROS) after EDI treatment was correlated with a reduction of hypoxic damage (eNOS and Caveolin-1) and significant increase of oxidation-reduction potential. Additionally, an increased expression of TGFβ, PDGFα/β, and HO-1 which are indicative for vascular protective function were observed after EDI exposure. EDI treatment preserves functionality and integrity of endothelial and intimal cells. Therefore, EDI may have the potential to reduce the occurrence of graft disease and failure in RA grafts in patients undergoing CABG.
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Affiliation(s)
- Thomas Aschacher
- Department of Cardio-Vascular Surgery, Clinic Floridsdorf and Karl Landsteiner Institute for Cardio-Vascular Research, Vienna, Austria.,Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Ulrike Baranyi
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Olivia Aschacher
- Department of Plastic, Reconstructive and Plastic Surgery, Medical University Vienna, Vienna, Austria
| | - Eva Eichmair
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Barbara Messner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Roxana Moayedifar
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Maximilian Y Emmert
- Cardiovascular Surgery, Charite-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Sigrid E Sandner
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
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Graft Preservation Solution DuraGraft ® Alleviates Vascular Dysfunction Following In Vitro Ischemia/Reperfusion Injury in Rats. Pharmaceuticals (Basel) 2021; 14:ph14101028. [PMID: 34681252 PMCID: PMC8538682 DOI: 10.3390/ph14101028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/17/2022] Open
Abstract
Vascular ischemia/reperfusion injury (IRI) in patients undergoing coronary artery bypass grafting can result in graft failure and the need for repeat revascularization procedures. DuraGraft® has been shown to protect structure and function in saphenous vein grafts against IRI. We compared the effect of DuraGraft® to saline solution on arterial grafts submitted to IRI. Rat thoracic aortic rings were harvested and immediately mounted in organ bath chambers (control, n = 7 rats) or underwent cold ischemic preservation either in saline (IR, n = 9 rats) or DuraGraft® (IR+Dura, n = 9 rats). Vascular function was measured ex vivo and immunohistochemistry was performed. Impaired maximum vasorelaxation (Rmax) to ACh in the IR-group compared to controls was ameliorated by DuraGraft®, indicating an improvement in endothelial function (Rmax to ACh (%): IR + Dura 73 ± 2 vs. IR 48 ± 3, p < 0.05). Additionally, decreased aortic ring sensitivity to ACh (pD2-value: -log 50% maximum response) seen after IR in the saline group was increased by DuraGraft® (pD2 to ACh: IR+Dura 7.1 ± 0.1 vs. IR 6.3 ± 0.2, p < 0.05). Impaired maximum contractile response to phenylephrine and high potassium chloride concentrations in the IR group compared to controls was significantly improved by DuraGraft®. DuraGraft® alleviates vascular dysfunction following IRI by reducing nitro-oxidative stress and the expression of ICAM-1, without leukocytes engagement.
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12
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Storage solutions to improve grafts preservation and longevity in coronary artery bypass grafting surgery: hype or hope? Curr Opin Cardiol 2021; 36:616-622. [PMID: 34397467 DOI: 10.1097/hco.0000000000000875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Saphenous vein grafts (SVGs) remain the most-commonly used conduits for coronary artery bypass grafting (CABG).Significant rates of vein graft failure (VGF) remain a limitation of their use as this diminishes the long-term benefits of CABG. The choice of intraoperative SVGs preservation solution is believed to have an impact on graft patency; however, the superiority of one solution over the others remains in question. RECENT FINDINGS In the present review, we describe the pathophysiological mechanisms underlying the different phases of VGF. We also reviewed the most recent literature comparing and evaluating the efficacy of various storage solutions. These include heparinized saline, autologous heparinized blood, buffered solutions, and crystalloid cardioplegia. SUMMARY It is clear that the composition of the SVGs storage solution has an impact on vessel wall structure and function. There is a lack of translational and clinical research on the topic; thus, conclusions cannot be drawn regarding the superiority of one solution over the others in terms of VGF. Future research needs to be conducted to address this gap in the literature in order to make meaningful evidence-based recommendations on intraoperative graft storage.
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Caliskan E, Pachuk CJ, Perrault LP, Emmert MY. Preservation solutions to improve graft patency: The devil is in the detail. J Cardiothorac Surg 2020; 15:228. [PMID: 32854755 PMCID: PMC7457275 DOI: 10.1186/s13019-020-01267-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022] Open
Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | | | - Louis P Perrault
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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14
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Sandner SE, Pachuk CJ, Aschacher T, Milojevic M, Caliskan E, Emmert MY. Endothelial damage inhibitors for improvement of saphenous vein graft patency in coronary artery bypass grafting. Minerva Cardioangiol 2020; 68:480-488. [PMID: 32326681 DOI: 10.23736/s0026-4725.20.05234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The saphenous vein graft (SVG) remains the most commonly used conduit in coronary artery bypass grafting (CABG). In light of this further research must be aimed at the development of strategies to optimize SVG patency and thereby improve both short- and long-term outcomes of CABG surgery. SVG patency in large part depends on the protection of the structural and functional integrity of the vascular endothelium at the time of conduit harvesting, including optimal storage conditions to prevent endothelial damage. This review provides an overview of currently available storage and preservation solutions, including novel endothelial damage inhibitors, and their role in mitigating endothelial damage and vein graft failure.
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Affiliation(s)
- Sigrid E Sandner
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria -
| | | | - Thomas Aschacher
- Division of Cardiac Surgery, Department of Surgery, Medical University Vienna, Vienna, Austria
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Etem Caliskan
- Department of Cardiovascular Surgery, Charite University of Medicine, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charite University of Medicine, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
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Fouquet O, Blossier JD, Dang Van S, Robert P, Barbelivien A, Pinaud F, Binuani P, Eid M, Henrion D, Baufreton C, Loufrani L. Do storage solutions protect endothelial function of arterialized vein graft in an experimental rat model? J Cardiothorac Surg 2020; 15:34. [PMID: 32041642 PMCID: PMC7011455 DOI: 10.1186/s13019-020-1077-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/30/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This study aims to compare the effects of storage solutions commonly used in coronary artery bypass grafting on the vascular reactivity in vein graft interposed in arterial position in syngeneic rats. METHODS Twenty-seven male Lewis rats were sacrified to sample a vein graft implanted 6 weeks ago into abdominal aorta position. The vein grafts were inferior venae cavae initially pretreated with heparinized saline solution (HS) or autologous heparinized blood (AHB) or our referent solution, GALA. The endothelial functionality, the in situ Reactive Oxygen Species (ROS) levels and the histological characteristics were conducted from segments of arterialized vein graft. RESULTS At 6 weeks, graft thrombosis occurred respectively in 22% of AHB group, 62.5% in the HS group and 82.5% in the GALA group. In each group, significative intimal hyperplasia was observed. After 6 weeks, an endothelium-remodeling layer associated with an increase of wall thickness was observed in each group. Endothelium-dependent tone was reduced in the vein graft regardless of the group. No difference was observed concerning the ROS in vein graft between the different groups. In distal aortic sections, ROS levels were increased in HS and GALA groups. CONCLUSIONS Storage solutions used in this experimental model of vein graft implanted in arterial position cause graft injury and a complete disappearance of vascular reactivity. GALA solution did not reduce intimal risk hyperplasia when the vein graft was exposed to arterial flow in a rat model.
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Affiliation(s)
- Olivier Fouquet
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France.
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France.
| | - Jean-David Blossier
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- Department of Cardiac Surgery, CHU Dupuytren, Limoges, France
| | - Simon Dang Van
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Pauline Robert
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | | | - Frédéric Pinaud
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Patrice Binuani
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
| | - Maroua Eid
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
| | - Daniel Henrion
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- University Hospital of Angers, Angers, France
| | - Christophe Baufreton
- Department of Cardiac Surgery, University Hospital of Angers, France, 4 rue Larrey, 49933 CHU, Angers Cedex 9, France
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
| | - Laurent Loufrani
- Institute MITOVASC CNRS UMR 6015, INSERM 1083, Angers, France
- University Hospital of Angers, Angers, France
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Sequential multidetector computed tomography assessments after venous graft treatment solution in coronary artery bypass grafting. J Thorac Cardiovasc Surg 2019; 161:96-106.e2. [PMID: 31866081 DOI: 10.1016/j.jtcvs.2019.10.115] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To assess the effect of DuraGraft (Somahlution Inc, Jupiter, Fla), an intraoperative graft treatment, on saphenous vein grafts in patients undergoing isolated coronary artery bypass grafting. METHODS Within patients, 2 saphenous vein grafts were randomized to DuraGraft or heparinized saline. Multidetector computed tomography angiography at 1, 3, and 12 months assessed change in wall thickness (primary end point at 3 months), lumen diameter, and maximum narrowing for the whole graft and the proximal 5-cm segment. Safety end points included graft occlusion, death, myocardial infarction, and repeat revascularization. RESULTS At 3 months, no significant changes were observed between DuraGraft- and saline-treated grafts (125 each) for wall thickness, lumen diameter, and maximum narrowing. At 12 months, DuraGraft-treated grafts demonstrated smaller mean wall thickness, overall (0.12 ± 0.06 vs 0.20 ± 0.31 mm; P = .02) and in the proximal segment (0.11 ± 0.03 vs 0.21 ± 0.33 mm; P = .01). Changes in wall thickness were greater in the proximal segment of saline-treated grafts (0.09 ± 0.29 vs 0.00 ± 0.03 mm; P = .04). Increase in maximum graft narrowing was larger in the proximal segment in the saline-treated grafts (4.7% ± 12.7% vs 0.2% ± 3.8%; P = .01). Nine DuraGraft and 11 saline grafts had occluded or thrombosed. One myocardial infarction was associated with a saline graft occlusion. No deaths or revascularizations were observed. CONCLUSIONS DuraGraft demonstrated a favorable effect on wall thickness at 12 months, particularly in the proximal segment. Longer-term follow-up in larger studies is needed to evaluate the effect on clinical outcomes.
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18
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Pachuk CJ, Rushton-Smith SK, Emmert MY. Intraoperative storage of saphenous vein grafts in coronary artery bypass grafting. Expert Rev Med Devices 2019; 16:989-997. [DOI: 10.1080/17434440.2019.1682996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Maximilian Y. Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Caliskan E, Sandner S, Misfeld M, Aramendi J, Salzberg SP, Choi YH, Satishchandran V, Iyer G, Perrault LP, Böning A, Emmert MY. A novel endothelial damage inhibitor for the treatment of vascular conduits in coronary artery bypass grafting: protocol and rationale for the European, multicentre, prospective, observational DuraGraft registry. J Cardiothorac Surg 2019; 14:174. [PMID: 31615560 PMCID: PMC6794868 DOI: 10.1186/s13019-019-1010-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/30/2019] [Indexed: 11/15/2022] Open
Abstract
Background Vein graft disease (VGD) impairs graft patency rates and long-term outcomes after coronary artery bypass grafting (CABG). DuraGraft is a novel endothelial-damage inhibitor developed to efficiently protect the structural and functional integrity of the vascular endothelium. The DuraGraft registry will evaluate the long-term clinical outcomes of DuraGraft in patients undergoing CABG procedures. Methods This ongoing multicentre, prospective observational registry will enrol 3000 patients undergoing an isolated CABG procedure or a combined procedure (ie, CABG plus valve surgery or other surgery) with at least one saphenous vein grafts or one free arterial graft (ie, radial artery or mammary artery). If a patient is enrolled, all free grafts (SVG and arterial will be treated with DuraGraft. Data on baseline, clinical, and angiographic characteristics as well as procedural and clinical events will be collected. The primary outcome measure is the occurrence of a major adverse cardiac event (MACE; defined as death, non-fatal myocardial-infarction, or need for repeat-revascularisation). Secondary outcome measures are the occurrence of major adverse cardiac and cerebrovascular events (MACCE; defined as death, non-fatal myocardial-infarction, repeat-revascularisation, or stroke), patient-reported quality of life, and health-economic data. Patient assessments will be performed during hospitalisation, at 1-month, 1-year, and annually thereafter to 5 years post-CABG. Events will be adjudicated by an independent clinical events committee. This European, multi-institutional registry will provide detailed insights into clinical outcome associated with DuraGraft. Discussion This European, multi-institutional registry will provide detailed insights into clinical outcome associated with the use of DuraGraft. Beyond that, and given the comprehensive data sets comprising of patient, procedural, and graft parameters that are being collected, the registry will enable for multiple subgroup analyses targeting focus groups or specific clinical questions. These may include analysis of subpopulations such as patients with diabetes or multimorbid high-risk patients (patient level), evaluation of relevance of harvesting technique including endoscopic versus open conduit harvesting (procedural level), or particular graft-specific aspects (conduit level). Trial registration ClinicalTrials.gov NCT02922088. Registered October 3, 2016. Ethics and dissemination The regional ethics committees have approved the registry. Results will be submitted for publication.
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Affiliation(s)
- Etem Caliskan
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Sigrid Sandner
- Department of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin Misfeld
- University Clinic of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jose Aramendi
- Division of Cardiac Surgery, Hospital de Cruces, Barakaldo, Spain
| | | | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University Hospital of Cologne, Cologne, Germany
| | | | | | - Louis P Perrault
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Andreas Böning
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, Gießen, Germany
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany. .,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
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Effectiveness and safety of using a novel endothelial damage inhibitor in arteriovenous fistula formation. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.788906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol 2019; 17:155-169. [DOI: 10.1038/s41569-019-0249-3] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
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