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Yuki H, Sundt TM, Niida T, Suzuki K, Kinoshita D, Fujimoto D, Dey D, Lee H, McNulty I, Naganuma T, Nakamura S, Usui E, Kakuta T, Jang I. Level of Perivascular Inflammation Is Significantly Lower Around the Left Internal Mammary Artery Than Around Native Coronary Arteries. J Am Heart Assoc 2024; 13:e033224. [PMID: 38879462 PMCID: PMC11255748 DOI: 10.1161/jaha.123.033224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 05/16/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND The left internal mammary artery (LIMA) is protected from developing atherosclerosis. Perivascular inflammation, which is closely associated with atherosclerosis, can be measured by perivascular adipose tissue attenuation on computed tomography angiography. Whether the absence of atherosclerosis in LIMA is related to the lower level of perivascular inflammation is unknown. This study was performed to compare the level of perivascular inflammation between LIMA in situ and native coronary arteries in patients with coronary artery disease. METHODS AND RESULTS A total of 573 patients who underwent both computed tomography angiography and optical coherence tomography imaging were included. The level of perivascular adipose tissue attenuation between LIMA in situ and coronary arteries was compared. Perivascular adipose tissue attenuation around LIMA in situ was significantly lower around the 3 coronary arteries (-82.9 [-87.3 to -78.0] versus -70.8 [-75.9 to -65.9]; P<0.001), irrespective of the level of pericoronary inflammation or the number of vulnerable features on optical coherence tomography. When patients were divided into high and low pericoronary inflammation groups, those in the high inflammation group had more target vessel failure (hazard ratio, 2.97 [95% CI, 1.16-7.59]; P=0.017). CONCLUSIONS The current study demonstrated that perivascular adipose tissue attenuation was significantly lower around LIMA in situ than around native coronary arteries. The lower level of perivascular inflammation may be related to the low prevalence of atherosclerosis in LIMA. REGISTRATION URL: https://www.clinicaltrials.gov; Unique Identifier: NCT04523194.
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Affiliation(s)
- Haruhito Yuki
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Thoralf M. Sundt
- Cardiac Surgery Division, Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Takayuki Niida
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Keishi Suzuki
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Daisuke Kinoshita
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Daichi Fujimoto
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars‐Sinai Medical CenterLos AngelesCA
| | - Hang Lee
- Biostatistics CenterMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Iris McNulty
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Toru Naganuma
- Interventional Cardiology UnitNew Tokyo HospitalChibaJapan
| | - Sunao Nakamura
- Interventional Cardiology UnitNew Tokyo HospitalChibaJapan
| | - Eisuke Usui
- Department of CardiologyTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Tsunekazu Kakuta
- Department of CardiologyTsuchiura Kyodo General HospitalTsuchiuraJapan
| | - Ik‐Kyung Jang
- Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonMA
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Goldberg LA, Zomer HD, McFetridge C, McFetridge PS. Silica nanoparticles enhance interfacial self-adherence of a multi-layered extracellular matrix scaffold for vascular tissue regeneration. Biotechnol Lett 2024; 46:469-481. [PMID: 38368285 DOI: 10.1007/s10529-024-03469-0] [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: 12/03/2023] [Revised: 12/03/2023] [Accepted: 01/10/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE Based on the clinical need for grafts for vascular tissue regeneration, our group developed a customizable scaffold derived from the human amniotic membrane. Our approach consists of rolling the decellularized amniotic membrane around a mandrel to form a multilayered tubular scaffold with tunable diameter and wall thickness. Herein, we aimed to investigate if silica nanoparticles (SiNP) could enhance the adhesion of the amnion layers within these rolled grafts. METHODS To test this, we assessed the structural integrity and mechanical properties of SiNP-treated scaffolds. Mechanical tests were repeated after six months to evaluate adhesion stability in aqueous environments. RESULTS Our results showed that the rolled SiNP-treated scaffolds maintained their tubular shape upon hydration, while non-treated scaffolds collapsed. By scanning electron microscopy, SiNP-treated scaffolds presented more densely packed layers than untreated controls. Mechanical analysis showed that SiNP treatment increased the scaffold's tensile strength up to tenfold in relation to non-treated controls and changed the mechanism of failure from interfacial slipping to single-point fracture. The nanoparticles reinforced the scaffolds both at the interface between two distinct layers and within each layer of the extracellular matrix. Finally, SiNP-treated scaffolds significantly increased the suture pullout force in comparison to untreated controls. CONCLUSION Our study demonstrated that SiNP prevents the unraveling of a multilayered extracellular matrix graft while improving the scaffolds' overall mechanical properties. In addition to the generation of a robust biomaterial for vascular tissue regeneration, this novel layering technology is a promising strategy for a number of bioengineering applications.
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Affiliation(s)
- Leslie A Goldberg
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Helena D Zomer
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Calum McFetridge
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA
| | - Peter S McFetridge
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-56, 1275 Center Drive, Gainesville, FL, 32611-6131, USA.
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Laugesen S, Krasniqi L, Benhassen LL, Mortensen PE, Pallesen PA, Bak S, Kjelsen BJ, Riber LP. How to harvest the left internal mammary artery-a randomized controlled trial. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae102. [PMID: 38775645 PMCID: PMC11139514 DOI: 10.1093/icvts/ivae102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/01/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES It is uncertain whether Thunderbeat has a place in harvesting the left internal mammary artery (LIMA) and whether skeletonization is superior to pedicle-harvested LIMA. Some investigations have shown improved flowrates in the skeletonized graft. The aim of this study was to compare 3 groups of harvesting techniques: Pedicled, surgical skeletonized and skeletonized with Thunderbeat in terms of flow rates in the LIMA and postoperative in-hospital outcomes. METHODS Patients undergoing coronary artery bypass grafting with the LIMA to the anterior descending artery were randomized to pedicled (n = 56), surgical skeletonized (n = 55) and skeletonized with Thunderbeat (n = 54). Main outcomes were blood flow and pulsatility index in the graft. RESULTS No statistical difference between groups regarding flow in LIMA or pulsatility index. Similarly, no difference in postoperative bleeding or days of hospitalization. The duration of harvesting was faster for the pedicled technique compared with surgical skeletonized and skeletonized with Thunderbeat [mean total min: pedicled 20.2 min standard deviation (SD) ± 5.4; surgical skeletonized 28.6 min SD ± 8.7; skeletonized with Thunderbeat 28.3 min SD ± 9.11, P < 0.001]. No grafts discarded due to faulty harvesting and there was no graft failure within hospital stay. CONCLUSIONS We found no difference between the harvesting methods except for a significantly faster harvesting time with the pedicled technique. However, non-touch skeletonized LIMA harvesting with Thunderbeat seems to be an effective alternative to traditional surgical skeletonized LIMA. The future will reveal whether patency is harvesting dependent. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05562908.
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Affiliation(s)
- Sofie Laugesen
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark
| | - Lytfi Krasniqi
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark
| | - Leila Louise Benhassen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Poul Erik Mortensen
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Peter Appel Pallesen
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Søren Bak
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Bo Juel Kjelsen
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Lars Peter Riber
- Department of Cardio, Vascular and Thoracic Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Medicine, Faculty of Health, Odense University, Odense, Denmark
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Momin A, Ranjan R, Valencia O, Jacques A, Lim P, Fluck D, Chua TP, Chandrasekaran V. Long Term Survival Benefits of Different Conduits Used in Coronary Artery Bypass Graft Surgery- A Single Institutional Practice Over 20 Years. J Multidiscip Healthc 2024; 17:1505-1512. [PMID: 38617079 PMCID: PMC11011645 DOI: 10.2147/jmdh.s461567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/03/2024] [Indexed: 04/16/2024] Open
Abstract
Objective This study determined hazard factors and long-term survival rate of total arterial coronary artery bypass graft surgery over 20 years in an extensively large, population-based cohort. Methods A total of 2979 patients who underwent isolated CABG from April 1999 to March 2020 were studied in 4 groups- Group-A (bilateral internal mammary artery ± radial artery), Group-B (single internal mammary artery + radial artery ± saphenous vein), Group-C (single internal mammary artery ± saphenous vein; no radial artery), and Group-D (radial artery ± saphenous vein; no internal mammary artery). The study endpoints analysed the correlation between the number and types of grafts with the survival time following isolated CABG surgery. Results The total arterial revascularization (Group A) group had an admirable mean long-term survival of ~19 years, compared to 18.6 years (Group B), 15.86 years (Group C), and 10.99 years (Group D). A Kaplan-Meier curve demonstrated confidence interval (CI) for study groups- (95% CI 18.33-19.94), (95% CI 18.14-19.06), (95% CI 15.40-16.32), and (95% CI 9.61-12.38) in Group A, B, C, D respectively. In the Holm-Sidak method analysis, significant associations existed between the number of arterial grafts and the long-term outcome. A statistically significant (P≤0.05) long-term survival advantage for arterial grafting was demonstrated, especially total arterial revascularisation over all other combinations except single internal mammary artery + radial artery grafting. Conclusion In this series, over 20 years, total arterial CABG use has excellent long-term survival, achieving complete myocardial revascularisation. There is no significant difference between the BIMA group and SIMA with radial artery. However, there is a reduced survival with decreased use of arterial conduits.
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Affiliation(s)
- Aziz Momin
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Redoy Ranjan
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Oswaldo Valencia
- Department of Cardiac Surgery, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Adam Jacques
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Pitt Lim
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter’s Hospitals NHS Foundation Trust, London, UK
| | - Tuan P Chua
- Department of Cardiology, Royal Surrey NHS Foundation Trust, London, UK
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Benke K, Stengl R, Stark KA, Bai Y, Radovits T, Loganathan S, Korkmaz-Icöz S, Csonka M, Karck M, Szabó G, Veres G. Zinc-aspirin preconditioning reduces endothelial damage of arterial grafts in a rodent model of revascularization. Front Cardiovasc Med 2024; 10:1288128. [PMID: 38239873 PMCID: PMC10794572 DOI: 10.3389/fcvm.2023.1288128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure. The prognosis of revascularization via CABG is determined by the patency of the used grafts, for which an intact endothelium is essential. The degree of ischemia-reperfusion injury (IRI), which occurs during the harvest and implantation of the grafts, is an important determinant of graft patency. Preconditioning with aspirin, a nonsteroidal anti-inflammatory drug has been shown to reduce the functional and molecular damage of arterial grafts in a rodent model. Studies have found that the zinc-aspirin complex may be able to exert an even better protective effect in pathological cardiovascular conditions. Thus, our aim was to characterize the protective effect of zinc-aspirin complex on free arterial grafts in a rodent model of revascularization. Methods Donor Lewis rats were treated with either zinc-aspirin, aspirin, or placebo (n = 8) for 5 days, then the aortic arches were harvested and stored in cold preservation solution and implanted heterotopically in the abdominal cavity of the recipient rats, followed by 2 h of reperfusion. There was also a non-ischemia-reperfusion control group (n = 8). Functional measurements using organ bath and histomorphological changes using immunohistochemistry were analyzed. Results The endothelium dependent maximal vasorelaxation was improved (non-transplanted control group: 82% ± 3%, transplanted control group: 14% ± 2%, aspirin group: 31% ± 4%, zinc-aspirin group: 52% ± 4%), the nitro-oxidative stress and cell apoptosis decreased, and significant endothelial protection was shown in the groups preconditioned with aspirin or zinc-aspirin. However, zinc-aspirin proved to be more effective in the reduction of IRI, than aspirin alone. Discussion Preconditioning with zinc-aspirin could be a promising way to protect the function and structural integrity of free arterial grafts, thus improving the outcomes of CABG.
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Affiliation(s)
- Kálmán Benke
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Roland Stengl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Klára Aliz Stark
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Yang Bai
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sivakkanan Loganathan
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sevil Korkmaz-Icöz
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Máté Csonka
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Gábor Veres
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
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Yusuf MM, Bansal V, Gunasekaran S, Kaliyamoorthy D, Kumar AM. Total arterial revascularization using robot assisted minimally invasive coronary artery bypass: an Indian experience. Indian J Thorac Cardiovasc Surg 2024; 40:42-49. [PMID: 38125327 PMCID: PMC10728025 DOI: 10.1007/s12055-023-01593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 12/23/2023] Open
Abstract
Objective The aim of this study is to analyze the early outcomes of Total Arterial Revascularization using Robot Assisted Minimally Invasive Coronary Artery Bypass at our center between June 2019 and January 2023. Methods This is a retrospective analysis of 195 patients who underwent Total Arterial Coronary Revascularization through Robot Assisted Minimally Invasive Coronary Artery Bypass procedure (RA-CABG) during the period of June 2019 and January 2023 in a quaternary care center in India. Primary outcome variables were in-hospital and 30-day mortality. Secondary outcome variables included duration of surgery, length of intensive care unit (ICU) stay, in-hospital stay and perioperative morbidity. The entire patient population was divided into two groups for a subgroup analysis based on when the surgery was conducted i.e. the years since the robotic program was begun at our institution with 81 patients in group I (2019-2021), and 114 patients in group II (2022-2023). Results 195 patients [88.7% male, mean age of 61.34 ± 9.58 years] underwent RA-CABG during the 5-year period (2019-2023) by a single experienced surgeon and his team. Conversion to larger thoracic incisions was required in 5 cases (2.59%). In-hospital and 30-day mortality was 1.02% each. The average length of ICU stay and hospital stay were 2.82 ± 1.17 days and 5.84 ± 1.71 days respectively. The duration of ICU stay correlated with the number of internal mammary artery grafts procured (p = 0.0022). Median duration of follow-up was 11 months. Overall mortality was 3.62% and cardiac related mortality was 2.07%, and 5 patients (2.59%) underwent percutaneous coronary intervention. Results of the sub-group analysis revealed a statistically significant difference between the groups in terms of number of internal mammary artery grafts procured (p = 0.010), need for transfusions (p = 0.00031), ICU stay (p = 0.0005) and in-hospital stay (p = 0.0006). Conclusions Total Arterial Coronary Revascularization through RA-CABG is a viable procedure in select patients. An experienced surgeon and team are required. Further studies in the form of randomized trials with long term follow-up are required to establish the overall utility, effectiveness and benefits to the patients.
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Affiliation(s)
| | - Varun Bansal
- Apollo Heart Institute, Indraprastha Apollo Hospital, Mathura Road, New Delhi, 110076 India
| | | | | | - Aishwarya Mahesh Kumar
- Apollo Heart Institute, Apollo Hospitals, Greams Road, Chennai, 600006 India
- Department of Medical Services, Apollo Hospital, Greams Road, Chennai, India
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Vanezis A. Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report. Interv Cardiol 2023; 18:e27. [PMID: 38213744 PMCID: PMC10782429 DOI: 10.15420/icr.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 01/13/2024] Open
Abstract
Guide-catheter-induced ostial coronary artery dissection is a feared complication of percutaneous coronary intervention, but thankfully the incidence is low. We describe a case of catheter-induced ostial dissection of the left internal mammary artery (LIMA) with multiple radial jump grafts during percutaneous coronary intervention of radial graft bifurcation disease via the LIMA. The dissection led to loss of flow and profound haemodynamic compromise and cardiac arrest as the LIMA supplied the majority of the myocardium in this patient. Intravascular ultrasound was not immediately available, so an Export AP thrombus aspiration catheter (Medtronic) was used over the coronary wire in place to allow the injection of contrast while simultaneously pulling back on the catheter to delineate the extent of the dissection and guide accurate drug-eluting stent placement. The report is a cautionary tale to the reader to treat the LIMA with respect and think long and hard before considering any interventional procedure that uses the LIMA as a conduit.
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Affiliation(s)
- Andrew Vanezis
- Trent Cardiac Centre, Nottingham City Hospital Nottingham, UK
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Hennessy C, Henry J, Parameswaran G, Brameier D, Kharbanda R, Myerson S. Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease: An Updated Systematic Review and Meta-Analysis. Cureus 2023; 15:e48297. [PMID: 38058336 PMCID: PMC10696914 DOI: 10.7759/cureus.48297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Recently, both US and European guidelines have predominantly recommended coronary artery bypass grafting (CABG) as the preferred revascularisation method. However, emerging data have raised the possibility of percutaneous coronary intervention (PCI) being a viable and effective alternative. This meta-analysis sought to evaluate the latest insights from major clinical trials to ascertain whether PCI could be as effective as CABG in treating left main coronary artery (LMCA) disease. To achieve this, a comprehensive systematic search was conducted across databases, including Medline (via PubMed), Embase, Cochrane, and clinicaltrials.gov. The search spanned from the inception of these databases to August 20, 2022, and exclusively focused on randomized controlled trials (RCTs). Employing the random effects model, selected studies underwent rigorous analysis. The study outcomes encompassed a spectrum of factors such as all-cause mortality, major adverse cerebrovascular and cardiovascular events (MACCE), myocardial infarction (MI), stroke, and revascularisation procedures. The observation periods of interest included the 30-day mark, 1 year, 5 years, and 10 years. The analysis integrated six RCTs, revealing noteworthy patterns. In terms of all-cause mortality, PCI demonstrated non-inferiority to CABG across all observed time frames: 30 days (OR 0.6), 1 year (OR 0.77), 5 years (OR 1.41), and 10 years (OR 1.08). Analysis of MACCE outcomes favored PCI at 30 days and CABG at 5 years. The utilisation of the original five-year EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularisation) trial definition for MI highlighted higher MI rates for PCI compared to CABG (OR 1.66, P < 0.05). Intriguingly, when the subsequently released EXCEL data, aligned with the third universal MI definition, was incorporated, the five-year data consistently leaned towards CABG. Specifically, the PCI group exhibited 7.5% MI rates in contrast to the 3.6% in the CABG cohort (OR 2.19, P < 0.001). Concerning stroke, PCI proved advantageous at 30 days and 1 year while exhibiting no significant disparity at 5 and 10 years. Revascularisation procedures favoured CABG at one and five years, with comparability at the remaining time points. In summation, the outcomes of this comprehensive meta-analysis suggest that PCI could serve as a feasible alternative to CABG in the context of uncomplicated LMCA disease. It's worth noting that CABG might still hold an advantage for complex lesions.
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Affiliation(s)
- Conor Hennessy
- Medicine and Surgery, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, GBR
| | - John Henry
- Medicine and Surgery, Oxford University Clinical Academic Graduate School, Oxford University Hospitals Foundation Trust, Oxford, GBR
| | | | - Devon Brameier
- Medicine and Surgery, Medical School Offices, Medical Sciences Division, University of Oxford, Oxford, GBR
| | - Rajesh Kharbanda
- Cardiology, Oxford Heart Centre, National Institute for Health and Care Research (NIHR) Biomedical Research Centre, Oxford University Hospitals, Oxford, GBR
- Cardiology, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, GBR
| | - Saul Myerson
- Cardiology, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, GBR
- Cardiology, Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
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Pineda-Castillo SA, Acar H, Detamore MS, Holzapfel GA, Lee CH. Modulation of Smooth Muscle Cell Phenotype for Translation of Tissue-Engineered Vascular Grafts. TISSUE ENGINEERING. PART B, REVIEWS 2023; 29:574-588. [PMID: 37166394 PMCID: PMC10618830 DOI: 10.1089/ten.teb.2023.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Translation of small-diameter tissue-engineered vascular grafts (TEVGs) for the treatment of coronary artery disease (CAD) remains an unfulfilled promise. This is largely due to the limited integration of TEVGs into the native vascular wall-a process hampered by the insufficient smooth muscle cell (SMC) infiltration and extracellular matrix deposition, and low vasoactivity. These processes can be promoted through the judicious modulation of the SMC toward a synthetic phenotype to promote remodeling and vascular integration; however, the expression of synthetic markers is often accompanied by a decrease in the expression of contractile proteins. Therefore, techniques that can precisely modulate the SMC phenotypical behavior could have the potential to advance the translation of TEVGs. In this review, we describe the phenotypic diversity of SMCs and the different environmental cues that allow the modulation of SMC gene expression. Furthermore, we describe the emerging biomaterial approaches to modulate the SMC phenotype in TEVG design and discuss the limitations of current techniques. In addition, we found that current studies in tissue engineering limit the analysis of the SMC phenotype to a few markers, which are often the characteristic of early differentiation only. This limited scope has reduced the potential of tissue engineering to modulate the SMC toward specific behaviors and applications. Therefore, we recommend using the techniques presented in this review, in addition to modern single-cell proteomics analysis techniques to comprehensively characterize the phenotypic modulation of SMCs. Expanding the holistic potential of SMC modulation presents a great opportunity to advance the translation of living conduits for CAD therapeutics.
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Affiliation(s)
- Sergio A. Pineda-Castillo
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, Oklahoma, USA
| | - Handan Acar
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Institute for Biomedical Engineering, Science and Technology, The University of Oklahoma, Norman, Oklahoma, USA
| | - Michael S. Detamore
- Stephenson School of Biomedical Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Institute for Biomedical Engineering, Science and Technology, The University of Oklahoma, Norman, Oklahoma, USA
| | - Gerhard A. Holzapfel
- Institute of Biomechanics, Graz University of Technology, Graz, Austria
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Chung-Hao Lee
- Biomechanics and Biomaterials Design Laboratory, School of Aerospace and Mechanical Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Institute for Biomedical Engineering, Science and Technology, The University of Oklahoma, Norman, Oklahoma, USA
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Ordiene R, Unikas R, Aldujeli A, Benetis R, Jakuska P, Ceponiene I, Jankauskas A, Plisiene J, Lenkutis T, Rudokaite G, Braukyliene R, Stonis M, Davies J, Punjabi PP. Instantaneous wave free ratio value impact on left internal mammary artery graft patency. Perfusion 2023; 38:1230-1239. [PMID: 35521921 PMCID: PMC10466988 DOI: 10.1177/02676591221099808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To assess whether instantaneous wave - free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG). BACKGROUND Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency. METHODS In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome. RESULTS In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 - 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 - 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 - 0.96)) were occluded (p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded (p < 0.001). In terms of MACCE, no difference (p = 1.0) was found between all 3 groups divided according to iFR value. CONCLUSIONS Instantaneous wave - free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.
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Affiliation(s)
- Rasa Ordiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramunas Unikas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ali Aldujeli
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Povilas Jakuska
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Indre Ceponiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antanas Jankauskas
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jurgita Plisiene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tadas Lenkutis
- Department of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gabriele Rudokaite
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rima Braukyliene
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Stonis
- Department of Anaesthesiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justin Davies
- Department of Cardiology, Imperial College London, Hammersmith Hospital, London, UK
| | - Prakash P Punjabi
- Division of Cardiothoracic Surgery, Imperial College London, Hammersmith Hospital, London, UK
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Alzghari T, Dimagli A, An KR, Cancelli G, Harik L, Perezgorvas-Olaria R, Soletti GJ, Gaudino M. Conduits and Strategies for Arterial Revascularization in CABG. Rev Cardiovasc Med 2023; 24:188. [PMID: 39077016 PMCID: PMC11266465 DOI: 10.31083/j.rcm2407188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 07/31/2024] Open
Abstract
Ischemic heart disease is the leading cause of death in the United States. Depending on the severity of the coronary artery disease, treatment options include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Although CABG has been performed since the 1970s, there is still debate onwhich conduit to use after the left internal thoracic artery. Currently, national registries report the left internal thoracic artery and the saphenous vein as the most commonly used conduits in CABG, while other arterial grafts, such as the radial artery, represent a minority, even though the current evidence suggests potential benefits of these arterial conduits. In this review, we aimed to describe the different types of arterial conduits used for CABG and summarize the evidence behind their use.
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Affiliation(s)
- Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Kevin R. An
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | | | - Giovanni Jr. Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY 10065, USA
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12
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Yamaguchi S, Uemura Y, Tanaka A, Takagi K, Ohashi T, Tanaka M, Umemoto N, Yoshida R, Negishi Y, Iwama M, Takemoto K, Watarai M, Kudo N, Morishima I, Tatami Y, Takada Y, Shimizu K, Yoshida Y, Tanaka T, Noda T, Ishii H, Murohara T. Long-term outcomes of percutaneous revascularization for internal mammary artery-left anterior descending artery bypass failure. Heart Vessels 2023; 38:157-163. [PMID: 35948801 DOI: 10.1007/s00380-022-02150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/20/2022] [Indexed: 01/10/2023]
Abstract
Despite the excellent long-term results of internal mammary artery (IMA)-left anterior descending (LAD) bypass, percutaneous revascularization of IMA is sometimes required for IMA-LAD bypass failure. However, its clinical outcomes have not been fully elucidated. The aim of this study was to investigate the long-term clinical outcomes, including target lesion revascularization (TLR) following contemporary percutaneous revascularization of failed IMA bypass graft. We examined data of 59 patients who had undergone percutaneous revascularization of IMA due to IMA-LAD bypass failure at nine hospitals. Patients with IMA graft used for Y-composite graft or sequential bypass graft were excluded. The incidence of TLR was primarily examined, whereas other clinical outcomes including cardiac death, myocardial infarction, and target vessel revascularization were also evaluated. Mean age of the enrolled patients was 67.4 ± 11.3 years, and 74.6% were men. Forty patients (67.8%) had anastomotic lesions, and 17 (28.8%) underwent revascularization within three months after bypass surgery. Procedural success was achieved in 55 (93.2%) patients. Stent implantation was performed in 13 patients (22.0%). During a median follow-up of 1401 days (interquartile range, 282-2521 days), TLR was required in six patients (8.5% at 1, 3, and 5 years). Patients who underwent percutaneous revascularization within 3 months after surgery tended to have a higher incidence of TLR. Clinical outcomes of IMA revascularization for IMA-LAD bypass failure were acceptable.
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Affiliation(s)
- Shogo Yamaguchi
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan.
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.,Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Ruka Yoshida
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Kenji Takemoto
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Masato Watarai
- Cardiovascular Center, Anjo Kosei Hospital, 28 Higashi-Hirokute, Anjo-cho, Anjo, 446-8602, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Shishkova D, Lobov A, Zainullina B, Matveeva V, Markova V, Sinitskaya A, Velikanova E, Sinitsky M, Kanonykina A, Dyleva Y, Kutikhin A. Calciprotein Particles Cause Physiologically Significant Pro-Inflammatory Response in Endothelial Cells and Systemic Circulation. Int J Mol Sci 2022; 23:ijms232314941. [PMID: 36499266 PMCID: PMC9738209 DOI: 10.3390/ijms232314941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Calciprotein particles (CPPs) represent an inherent mineral buffering system responsible for the scavenging of excessive Ca2+ and PO43- ions in order to prevent extraskeletal calcification, although contributing to the development of endothelial dysfunction during the circulation in the bloodstream. Here, we performed label-free proteomic profiling to identify the functional consequences of CPP internalisation by endothelial cells (ECs) and found molecular signatures of significant disturbances in mitochondrial and lysosomal physiology, including oxidative stress, vacuolar acidification, accelerated proteolysis, Ca2+ cytosolic elevation, and mitochondrial outer membrane permeabilisation. Incubation of intact ECs with conditioned medium from CPP-treated ECs caused their pro-inflammatory activation manifested by vascular cell adhesion molecule 1 (VCAM1) and intercellular adhesion molecule 1 (ICAM1) upregulation and elevated release of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1/ C-C motif ligand 2 (MCP-1/CCL2). Among the blood cells, monocytes were exclusively responsible for CPP internalisation. As compared to the co-incubation of donor blood with CPPs in the flow culture system, intravenous administration of CPPs to Wistar rats caused a considerably higher production of chemokines, indicating the major role of monocytes in CPP-triggered inflammation. Upregulation of sICAM-1 and IL-8 also suggested a notable contribution of endothelial dysfunction to systemic inflammatory response after CPP injections. Collectively, our results demonstrate the pathophysiological significance of CPPs and highlight the need for the development of anti-CPP therapies.
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Affiliation(s)
- Daria Shishkova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Arseniy Lobov
- Laboratory of Regenerative Biomedicine, Institute of Cytology of the RAS, 4 Tikhoretskiy Prospekt, 194064 St. Petersburg, Russia
| | - Bozhana Zainullina
- Centre for Molecular and Cell Technologies, St. Petersburg State University, Universitetskaya Embankment, 7/9, 199034 St. Petersburg, Russia
| | - Vera Matveeva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Victoria Markova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anna Sinitskaya
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Elena Velikanova
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Maxim Sinitsky
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anastasia Kanonykina
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Yulia Dyleva
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
| | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia
- Correspondence: ; Tel.: +7-960-907-7067
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14
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Nappi F, Fiore A, Masiglat J, Cavuoti T, Romandini M, Nappi P, Avtaar Singh SS, Couetil JP. Endothelium-Derived Relaxing Factors and Endothelial Function: A Systematic Review. Biomedicines 2022; 10:2884. [PMID: 36359402 PMCID: PMC9687749 DOI: 10.3390/biomedicines10112884] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The endothelium plays a pivotal role in homeostatic mechanisms. It specifically modulates vascular tone by releasing vasodilatory mediators, which act on the vascular smooth muscle. Large amounts of work have been dedicated towards identifying mediators of vasodilation and vasoconstriction alongside the deleterious effects of reactive oxygen species on the endothelium. We conducted a systematic review to study the role of the factors released by the endothelium and the effects on the vessels alongside its role in atherosclerosis. METHODS A search was conducted with appropriate search terms. Specific attention was offered to the effects of emerging modulators of endothelial functions focusing the analysis on studies that investigated the role of reactive oxygen species (ROS), perivascular adipose tissue, shear stress, AMP-activated protein kinase, potassium channels, bone morphogenic protein 4, and P2Y2 receptor. RESULTS 530 citations were reviewed, with 35 studies included in the final systematic review. The endpoints were evaluated in these studies which offered an extensive discussion on emerging modulators of endothelial functions. Specific factors such as reactive oxygen species had deleterious effects, especially in the obese and elderly. Another important finding included the shear stress-induced endothelial nitric oxide (NO), which may delay development of atherosclerosis. Perivascular Adipose Tissue (PVAT) also contributes to reparative measures against atherosclerosis, although this may turn pathological in obese subjects. Some of these factors may be targets for pharmaceutical agents in the near future. CONCLUSION The complex role and function of the endothelium is vital for regular homeostasis. Dysregulation may drive atherogenesis; thus, efforts should be placed at considering therapeutic options by targeting some of the factors noted.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Joyce Masiglat
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Teresa Cavuoti
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Michela Romandini
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | | | - Jean-Paul Couetil
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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15
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Wang X, Chan V, Corridon PR. Acellular Tissue-Engineered Vascular Grafts from Polymers: Methods, Achievements, Characterization, and Challenges. Polymers (Basel) 2022; 14:polym14224825. [PMID: 36432950 PMCID: PMC9695055 DOI: 10.3390/polym14224825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Extensive and permanent damage to the vasculature leading to different pathogenesis calls for developing innovative therapeutics, including drugs, medical devices, and cell therapies. Innovative strategies to engineer bioartificial/biomimetic vessels have been extensively exploited as an effective replacement for vessels that have seriously malfunctioned. However, further studies in polymer chemistry, additive manufacturing, and rapid prototyping are required to generate highly engineered vascular segments that can be effectively integrated into the existing vasculature of patients. One recently developed approach involves designing and fabricating acellular vessel equivalents from novel polymeric materials. This review aims to assess the design criteria, engineering factors, and innovative approaches for the fabrication and characterization of biomimetic macro- and micro-scale vessels. At the same time, the engineering correlation between the physical properties of the polymer and biological functionalities of multiscale acellular vascular segments are thoroughly elucidated. Moreover, several emerging characterization techniques for probing the mechanical properties of tissue-engineered vascular grafts are revealed. Finally, significant challenges to the clinical transformation of the highly promising engineered vessels derived from polymers are identified, and unique perspectives on future research directions are presented.
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Affiliation(s)
- Xinyu Wang
- Department of Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
| | - Vincent Chan
- Department of Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Correspondence: (V.C.); (P.R.C.)
| | - Peter R. Corridon
- Department of Biomedical Engineering and Healthcare Engineering Innovation Center, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Department of Immunology and Physiology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Center for Biotechnology, Khalifa University, Abu Dhabi P.O. Box 127788, United Arab Emirates
- Correspondence: (V.C.); (P.R.C.)
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16
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Sanetra K, Buszman PP, Jankowska-Sanetra J, Cisowski M, Fil W, Gorycki B, Bochenek A, Slabon-Turska M, Konopko M, Kaźmierczak P, Gerber W, Milewski K, Buszman PE. One-stage hybrid coronary revascularization for the treatment of multivessel coronary artery disease— Periprocedural and long-term results from the “HYBRID-COR” feasibility study. Front Cardiovasc Med 2022; 9:1016255. [PMID: 36337903 PMCID: PMC9626513 DOI: 10.3389/fcvm.2022.1016255] [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: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background The constant growth of interest in hybrid coronary artery revascularization (HCR) is apparent. Yet, few studies report outcomes of the one-stage HCR. Consequently, the status of such procedures is not adequately supported in clinical guidelines. The aim of this study was to report the safety, feasibility, and long term-outcomes of the one-stage HCR. Methods and results Patients were enrolled in the prospective one-stage hybrid coronary revascularization program (HYBRID-COR). They underwent a one-stage hybrid revascularization procedure while on double antiplatelet therapy (DAPT) with Ticagrelor: endoscopic atraumatic coronary artery bypass grafting (EACAB) for revascularization of the left anterior descending (LAD) artery and percutaneous intervention in non-LAD arteries with contemporary drug-eluting stents. The composite primary endpoint included MACCE (major adverse cardiac and cerebrovascular events: death, myocardial infarction, stroke, and repeated revascularization) in long-term observation. The study cohort consisted of 30 patients (68% male) with stable coronary artery disease (26.7%) and unstable angina (73.3%). Procedural success was 100%. No death, myocardial infarction (MI), or stroke were observed in the perioperative period. One patient (3.3%) required chest revision and blood transfusion due to surgical bleeding. Kidney injury was noted in two patients (6.6%). In a long-term follow-up (median; IQR: 4.25; 2.62–4.69 years), two patients (6.6%) underwent repeated revascularization and one patient (3.3%) died due to MI. The overall primary endpoint rate was 9.9%. Conclusion One-stage hybrid revascularization, on DAPT, is a feasible, safe, and efficient way of achieving complete revascularization in selected patients. The complication rate is low and acceptable. Further randomized trials are required.
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Affiliation(s)
- Krzysztof Sanetra
- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Piotr Paweł Buszman
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- *Correspondence: Piotr Paweł Buszman,
| | | | - Marek Cisowski
- Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Wojciech Fil
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Bogdan Gorycki
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
| | - Monika Slabon-Turska
- Department of Obstetrics and Gynecology, Provincial Specialist Hospital, Wrocław, Poland
| | - Marta Konopko
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | | | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
| | - Krzysztof Milewski
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
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17
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Yamaguchi T, Morino K. Perivascular mechanical environment: A narrative review of the role of externally applied mechanical force in the pathogenesis of atherosclerosis. Front Cardiovasc Med 2022; 9:944356. [PMID: 36337892 PMCID: PMC9629355 DOI: 10.3389/fcvm.2022.944356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Atherosclerosis is promoted by systemic factors, such as dyslipidemia, hypertension, diabetes, and smoking, which cause atherosclerosis in blood vessels throughout the body. However, atherosclerotic lesions are characterized by their frequent occurrence in specific vessels and sites. Blood vessels are exposed to various mechanical forces related to blood pressure and flow. Although shear stress promotes the initiation and progression of atherosclerotic lesions, the pathogenesis of site specificity of atherosclerosis is not sufficiently explained by shear stress. We propose the concept of a perivascular mechanical environment (PVME). Compelling evidence suggests that site specificity in atherosclerotic lesions depends on a distinct local PVME. Atheroprone arteries, such as the coronary artery, are markedly affected by externally applied mechanical force (EMF), whereas atheroprotective arteries, such as the internal thoracic artery, are less affected. Recent studies have shown that the coronary artery is affected by cardiac muscle contraction, the carotid artery by the hyoid bone and the thyroid cartilage, and the abdominal aorta and lower extremity arteries by musculoskeletal motion. We speculate that the thoracic cage protects the internal thoracic artery from EMF owing to a favorable PVME. Furthermore, evidence suggests that plaque eccentricity is provided by EMF; plaques are frequently observed on an external force-applied side. In each vascular tree, site-specific characteristics of the PVME differ substantially, inducing individual atherogenicity. From the perspective of the mechanical environment, hemodynamic stress occurs in an inside-out manner, whereas EMF occurs in an outside-in manner. These inward and outward forces apply mechanical load individually, but interact synergistically. The concept of a PVME is a novel pathogenesis of atherosclerosis and also might be a pathogenesis of other arterial diseases.
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Affiliation(s)
| | - Katsutaro Morino
- Institutional Research Office, Shiga University of Medical Science, Otsu, Japan
- *Correspondence: Katsutaro Morino,
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18
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Ata EC, Şentürk GE, Saygi HI, Ulukan MÖ, Uğurlucan M, Erkanli K, Beyaz MO, Yildiz E. Identifying the optimal monopolar electrocautery output power in pedicular internal thoracic artery harvesting: 20 or 40 watts? Cardiovasc J Afr 2022; 33:243-247. [PMID: 35211717 PMCID: PMC9887438 DOI: 10.5830/cvja-2022-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/27/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Monopolar electrocautery is an important tool for harvesting the pedicular internal thoracic artery (ITA) in cardiac surgery. The different power outputs of cautery may affect graft integrity and long-term patency. This study aimed to identify the optimal threshold of electrocautery power for ITA harvest. METHODS This prospective study included 30 patients who underwent elective coronary artery bypass surgery at the Medipol Mega University Hospital. The ITA was harvested by monopolar electrocautery after a median sternotomy. The output of cautery was adjusted at 20 W in group A and 40 W in group B. Three to 4 cm of a distal ITA sample from each patient was examined under a light microscope by two independent pathologists. RESULTS The ITA harvest time was longer in group A (21.2 ± 7.5 vs 10.3 ± 8.1 min, p < 0.001) than in group B. ITA free flow was similar in the two groups (43.6 ± 48.7 vs 51.7 ± 45.0 Ml/min, p = 0.762). Mild to moderate injury in the endothelial and sub-endothelial sample was more frequent in the low-cautery group (p = 0.0037). CONCLUSIONS ITA endothelial integrity was found to be better preserved with 40W electrocautery. Moreover, 20W of monopolar electrocautery may not be safe in pedicular ITA harvesting.
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Affiliation(s)
- Emin Can Ata
- Clinic of Cardiovascular Surgery, Haseki Education and Research Hospital, Istanbul, Turkey.
| | - Gözde Erkanli Şentürk
- Department of Histology and Embryology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Halil Ibrahim Saygi
- Department of Histology and Embryology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mustafa Özer Ulukan
- Department of Cardiovascular Surgery, Medipol Mega University Hospital, Istanbul, Turkey
| | - Murat Uğurlucan
- Department of Cardiovascular Surgery, Medipol Mega University Hospital, Istanbul, Turkey
| | - Korhan Erkanli
- Department of Cardiovascular Surgery, Medipol Mega University Hospital, Istanbul, Turkey
| | - Metin Onur Beyaz
- Department of Cardiovascular Surgery, Tayfur Ata Sokmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey
| | - Erkan Yildiz
- Department of Cardiovascular Surgery, Medipol Mega University Hospital, Istanbul, Turkey
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Jinka SK, Jinka AG, Janis J. Computational Fluid Dynamic Evaluation of Deep Inferior Epigastric Artery Perforator (DIEP) Flap End-to-Side Anastomosis. Cureus 2022; 14:e24650. [PMID: 35663722 PMCID: PMC9156394 DOI: 10.7759/cureus.24650] [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] [Accepted: 04/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background End-to-side (ETS) microvascular anastomoses are utilized within deep inferior epigastric artery perforator (DIEP) flap breast reconstruction procedures. Optimization of these anastomoses via a computational fluid dynamic (CFD) model can minimize ischemia and contribute to flap success. Methods A CFD model of a deep inferior epigastric artery to internal mammary artery anastomosis was constructed with OpenFOAM software (OpenCFD Ltd., Bracknell, UK). Blood was modelled as an incompressible Newtonian fluid. Viscosity and density were assumed to be constant throughout the simulation. Mean arterial pressure was held constant at 100 mmHg. Individual virtual meshes were created for 30-, 45-, 60-, 75-, and 90-degree anastomotic angle simulations. Fluid flow was visualized with line integral convolution (LIC) and pure fluid velocity (PFV) techniques. Vessel wall shear stress (WSS) was also visualized. Results The LIC revealed blood recirculation was associated with large anastomotic angles with minimal to no recirculation seen in the 45- and 30-degree simulations. Any recirculation visualized was confined to the toe of the bifurcation. This recirculation was associated with stagnation in the toe of the graft vessel as well, as visualized by the PFV model. A linear relationship was identified between anastomotic angle and percentage of stagnant fluid, with stagnation increasing as the anastomotic angle increased. Wall shear stress increased with the anastomotic angle and was concentrated in the heel and toe of the model. Conclusions The CFD modelling shows that increased acuity of anastomotic angles in ETS DIEP flaps is essential to minimize stagnation, recirculation, and WSS. Successful implementation of this recommendation may directly decrease the risk of flap failure from ischemia.
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20
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Atherogenesis, Transcytosis, and the Transmural Cholesterol Flux: A Critical Review. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:2253478. [PMID: 35464770 PMCID: PMC9023196 DOI: 10.1155/2022/2253478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/19/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
The recently described phenomenon of cholesterol-loaded low-density lipoproteins (LDL) entering the arterial wall from the lumen by transcytosis has been accepted as an alternative for the long-held concept that atherogenesis involves only passive LDL movement across an injured or dysfunctional endothelial barrier. This active transport of LDL can now adequately explain why plaques (atheromas) appear under an intact, uninjured endothelium. However, the LDL transcytosis hypothesis is still questionable, mainly because the process serves no clear physiological purpose. Moreover, central components of the putative LDL transcytosis apparatus are shared by the counter process of cholesterol efflux and reverse cholesterol transport (RCT) and therefore can essentially create an energy-wasting futile cycle and paradoxically be pro- and antiatherogenic simultaneously. Hence, by critically reviewing the literature, we wish to put forward an alternative interpretation that, in our opinion, better fits the experimental evidence. We assert that most of the accumulating cholesterol (mainly as LDL) reaches the intima not from the lumen by transcytosis, but from the artery's inner layers: the adventitia and media. We have named this directional cholesterol transport transmural cholesterol flux (TCF). We suggest that excess cholesterol, diffusing from the avascular (i.e., devoid of blood and lymph vessels) media's smooth muscle cells, is cleared by the endothelium through its apical membrane. A plaque is formed when this cholesterol clearance rate lags behind its rate of arrival by TCF.
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Masroor M, Zhou K, Chen C, Fu X, Zhao Y. All we need to know about internal thoracic artery harvesting and preparation for myocardial revascularization: a systematic review. J Cardiothorac Surg 2021; 16:354. [PMID: 34961523 PMCID: PMC8711206 DOI: 10.1186/s13019-021-01733-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022] Open
Abstract
Internal thoracic arteries (ITAs) are the gold standard conduits for coronary revascularization because of their long-term patency and anti-atherosclerotic properties. Harvesting and preparation of ITAs for revascularization is a technically demanding procedure with multiple challenges. Over the last few decades, various methods and techniques for ITAs harvesting have been introduced by different surgeons and applied in clinical practice with different results. Harvesting of ITAs in pedicled or skeletonized fashion, with electrocautery or harmonic scalpel, with open or intact pleura, with clipping the end or keeping it perfused; papaverine delivery with intraluminal injection, perivascular injection, injecting into endothoracic fascia, and papaverine topical spray are the different techniques introduced by the number of researchers. At the same time, access to the ITAs for harvesting has also been studied. Access and harvesting through median sternotomy, mini anterolateral thoracotomy, thoracoscopic, and robotic-assisted harvesting of ITAs are the different techniques used in clinical practice. However, the single standard method for harvesting and preparation of ITAs has yet to be determined. In this review article, we aimed to discuss and analyze all these techniques of harvesting and preparing ITAs with the help of literature to find the best way for ITAs harvesting and preparation for myocardial revascularization.
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Affiliation(s)
- Matiullah Masroor
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China.,Department of Cardiothoracic and Vascular Surgery, Amiri Medical Complex, Qargha Rd, Afshar, Kabul, Afghanistan
| | - Kang Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Chunyang Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Xianming Fu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China
| | - Yuan Zhao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, 139 Renmin Middle Rd, Changsha, 410011, China.
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Błażejowska E, Urbanowicz T, Gąsecka A, Olasińska-Wiśniewska A, Jaguszewski MJ, Targoński R, Szarpak Ł, Filipiak KJ, Perek B, Jemielity M. Diagnostic and Prognostic Value of miRNAs after Coronary Artery Bypass Grafting: A Review. BIOLOGY 2021; 10:1350. [PMID: 34943265 PMCID: PMC8698870 DOI: 10.3390/biology10121350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022]
Abstract
MiRNAs are noncoding, 21-24 nucleotide-long RNA particles that control over 60% of genes. MiRNAs affect gene expression through binding to the 3'-untranslated region of messenger RNA (mRNA), thus inhibiting mRNA translation or inducing mRNA degradation. MiRNAs have been associated with various cardiovascular diseases, including heart failure, hypertension, left ventricular hypertrophy, or ischemic heart disease. In addition, miRNA expression alters during coronary artery bypass grafting (CABG) surgery, which could be used to predict perioperative outcomes. CABG is an operation in which complex coronary arteries stenosis is treated by bypassing atherosclerotic lesions with venous or arterial grafts. Despite a very low perioperative mortality rate and excellent long-term survival, CABG is associated with postoperative complications, including reperfusion injury, graft failure, atrial fibrillation and perioperative myocardial infarction. So far, no reliable diagnostic and prognostic tools to predict prognosis after CABG have been developed. Changes in the perioperative miRNA expression levels could improve the diagnosis of post-CABG myocardial infarction and atrial fibrillation and could be used to stratify risk after CABG. Herein, we describe the expression changes of different subtypes of miRNAs during CABG and review the diagnostic and prognostic utility of miRNAs in patients undergoing CABG.
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Affiliation(s)
- Ewelina Błażejowska
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Miłosz J. Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.J.J.); (R.T.)
| | - Radosław Targoński
- 1st Department of Cardiology, Medical University of Gdansk, 80-211 Gdansk, Poland; (M.J.J.); (R.T.)
| | - Łukasz Szarpak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland; (Ł.S.); (K.J.F.)
| | - Krzysztof J. Filipiak
- Department of Clinical Sciences, Maria Sklodowska-Curie Medical Academy, 03-411 Warsaw, Poland; (Ł.S.); (K.J.F.)
| | - Bartłomiej Perek
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (T.U.); (A.O.-W.); (B.P.); (M.J.)
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Jan A, Hayat MK, Khan MAA, Ullah R. Trends in per-operative parameters and postoperative complications associated with coronary artery bypass graft surgery (CABG); A four-year retrospective study. Pak J Med Sci 2021; 37:1734-1739. [PMID: 34912387 PMCID: PMC8613026 DOI: 10.12669/pjms.37.7.4315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the patterns of per-operative parameters and early outcomes of patients that underwent CABG surgery during a four-year period. Methods: This is a cross-sectional descriptive study conducted in a tertiary care of hospital from November 2020 to January 2021. All the patients that underwent the isolated coronary artery bypass grafting (CABG) procedure were included in the study from June 2017 till June 2020. Data was collected on a data extraction form and stored in SPSS format which was analyzed for qualitative statistics keeping p<0.05 as significant. All the results were represented in the form of tables. Results: A total of 1,613 patients were operated upon for Coronary Artery Bypass Grafting (CABG) procedure during the study period with 1,222 (75.8%) males and 391 (24.2%) females. Dyslipidemia (71.8%) was the most common risk factor. The average perfusion time decreased only slightly (~1 minute) from 96.01 minutes to 95.07 minutes (2017 to 2020). This change however was not significant (p=0.301). The rate of Left Internal Mammary Artery (LIMA) use stayed relatively stable over the 4-year period fluctuating between 88.7% and 92.9% (p=0.360). The average initial ICU stay (in hours), drain at 12 hours and 24 hours stays almost the same. The rate of mortality peaked in 2018 (4.76%) and subsequently fell to 3.57% by 2020. Conclusion: More males underwent CABG surgery at this tertiary care hospital and the overall complication rate and per-operative parameters improved over the years. The non-risk stratified mortality in this study was found to be higher than developed nations.
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Affiliation(s)
- Azam Jan
- Dr. Azam Jan, MD, Diplomate American Board of General Surgery (USA), Diplomate American Board of Thoracic (Cardiothoracic) Surgery (USA) Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Khizar Hayat
- Dr. Muhammad Khizar Hayat, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mohammad Ahmed Arsalan Khan
- Dr. Mohammad Ahmed Arsalan Khan, MBBS Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Rafi Ullah
- Dr. Rafi Ullah, MD. Department of Cardiothoracic & Vascular Surgery, Rehman Medical Institute (RMI), Peshawar, Khyber Pakhtunkhwa, Pakistan
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24
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Shishkova DK, Velikanova EA, Bogdanov LA, Sinitsky MY, Kostyunin AE, Tsepokina AV, Gruzdeva OV, Mironov AV, Mukhamadiyarov RA, Glushkova TV, Krivkina EO, Matveeva VG, Hryachkova ON, Markova VE, Dyleva YA, Belik EV, Frolov AV, Shabaev AR, Efimova OS, Popova AN, Malysheva VY, Kolmykov RP, Sevostyanov OG, Russakov DM, Dolganyuk VF, Gutakovsky AK, Zhivodkov YA, Kozhukhov AS, Brusina EB, Ismagilov ZR, Barbarash OL, Yuzhalin AE, Kutikhin AG. Calciprotein Particles Link Disturbed Mineral Homeostasis with Cardiovascular Disease by Causing Endothelial Dysfunction and Vascular Inflammation. Int J Mol Sci 2021; 22:ijms222212458. [PMID: 34830334 PMCID: PMC8626027 DOI: 10.3390/ijms222212458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/10/2021] [Accepted: 11/17/2021] [Indexed: 12/14/2022] Open
Abstract
An association between high serum calcium/phosphate and cardiovascular events or death is well-established. However, a mechanistic explanation of this correlation is lacking. Here, we examined the role of calciprotein particles (CPPs), nanoscale bodies forming in the human blood upon its supersaturation with calcium and phosphate, in cardiovascular disease. The serum of patients with coronary artery disease or cerebrovascular disease displayed an increased propensity to form CPPs in combination with elevated ionised calcium as well as reduced albumin levels, altogether indicative of reduced Ca2+-binding capacity. Intravenous administration of CPPs to normolipidemic and normotensive Wistar rats provoked intimal hyperplasia and adventitial/perivascular inflammation in both balloon-injured and intact aortas in the absence of other cardiovascular risk factors. Upon the addition to primary human arterial endothelial cells, CPPs induced lysosome-dependent cell death, promoted the release of pro-inflammatory cytokines, stimulated leukocyte adhesion, and triggered endothelial-to-mesenchymal transition. We concluded that CPPs, which are formed in the blood as a result of altered mineral homeostasis, cause endothelial dysfunction and vascular inflammation, thereby contributing to the development of cardiovascular disease.
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Affiliation(s)
- Daria K. Shishkova
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Elena A. Velikanova
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Leo A. Bogdanov
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Maxim Yu. Sinitsky
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Alexander E. Kostyunin
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Anna V. Tsepokina
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Olga V. Gruzdeva
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Andrey V. Mironov
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Rinat A. Mukhamadiyarov
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Tatiana V. Glushkova
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Evgenia O. Krivkina
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Vera G. Matveeva
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Oksana N. Hryachkova
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Victoria E. Markova
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Yulia A. Dyleva
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Ekaterina V. Belik
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Alexey V. Frolov
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Amin R. Shabaev
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Olga S. Efimova
- Institute of Coal Chemistry and Material Science, Federal Research Center of Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, 18 Sovetskiy Avenue, 650000 Kemerovo, Russia; (O.S.E.); (A.N.P.); (V.Y.M.); (R.P.K.); (Z.R.I.)
| | - Anna N. Popova
- Institute of Coal Chemistry and Material Science, Federal Research Center of Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, 18 Sovetskiy Avenue, 650000 Kemerovo, Russia; (O.S.E.); (A.N.P.); (V.Y.M.); (R.P.K.); (Z.R.I.)
| | - Valentina Yu. Malysheva
- Institute of Coal Chemistry and Material Science, Federal Research Center of Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, 18 Sovetskiy Avenue, 650000 Kemerovo, Russia; (O.S.E.); (A.N.P.); (V.Y.M.); (R.P.K.); (Z.R.I.)
| | - Roman P. Kolmykov
- Institute of Coal Chemistry and Material Science, Federal Research Center of Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, 18 Sovetskiy Avenue, 650000 Kemerovo, Russia; (O.S.E.); (A.N.P.); (V.Y.M.); (R.P.K.); (Z.R.I.)
| | - Oleg G. Sevostyanov
- Institute of Fundamental Sciences, Kemerovo State University, 6 Krasnaya Street, 650000 Kemerovo, Russia; (O.G.S.); (D.M.R.); (V.F.D.)
| | - Dmitriy M. Russakov
- Institute of Fundamental Sciences, Kemerovo State University, 6 Krasnaya Street, 650000 Kemerovo, Russia; (O.G.S.); (D.M.R.); (V.F.D.)
| | - Viatcheslav F. Dolganyuk
- Institute of Fundamental Sciences, Kemerovo State University, 6 Krasnaya Street, 650000 Kemerovo, Russia; (O.G.S.); (D.M.R.); (V.F.D.)
| | - Anton K. Gutakovsky
- Rzhanov Institute of Semiconductor Physics, Siberian Branch of the Russian Academy of Sciences, 13 Akademika Lavrentieva Avenue, 630090 Novosibirsk, Russia; (A.K.G.); (Y.A.Z.); (A.S.K.)
| | - Yuriy A. Zhivodkov
- Rzhanov Institute of Semiconductor Physics, Siberian Branch of the Russian Academy of Sciences, 13 Akademika Lavrentieva Avenue, 630090 Novosibirsk, Russia; (A.K.G.); (Y.A.Z.); (A.S.K.)
| | - Anton S. Kozhukhov
- Rzhanov Institute of Semiconductor Physics, Siberian Branch of the Russian Academy of Sciences, 13 Akademika Lavrentieva Avenue, 630090 Novosibirsk, Russia; (A.K.G.); (Y.A.Z.); (A.S.K.)
| | - Elena B. Brusina
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Zinfer R. Ismagilov
- Institute of Coal Chemistry and Material Science, Federal Research Center of Coal and Coal Chemistry, Siberian Branch of the Russian Academy of Sciences, 18 Sovetskiy Avenue, 650000 Kemerovo, Russia; (O.S.E.); (A.N.P.); (V.Y.M.); (R.P.K.); (Z.R.I.)
| | - Olga L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Arseniy E. Yuzhalin
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
| | - Anton G. Kutikhin
- Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (D.K.S.); (E.A.V.); (L.A.B.); (M.Y.S.); (A.E.K.); (A.V.T.); (O.V.G.); (A.V.M.); (R.A.M.); (T.V.G.); (E.O.K.); (V.G.M.); (O.N.H.); (V.E.M.); (Y.A.D.); (E.V.B.); (A.V.F.); (A.R.S.); (E.B.B.); (O.L.B.); (A.E.Y.)
- Correspondence: ; Tel.: +7-960-907-7067
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Mechanisms of vascular smooth muscle cell investment and phenotypic diversification in vascular diseases. Biochem Soc Trans 2021; 49:2101-2111. [PMID: 34495326 PMCID: PMC8589433 DOI: 10.1042/bst20210138] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/31/2022]
Abstract
In contrast with the heart, the adult mammalian vasculature retains significant remodelling capacity, dysregulation of which is implicated in disease development. In particular, vascular smooth muscle cells (VSMCs) play major roles in the pathological vascular remodelling characteristic of atherosclerosis, restenosis, aneurysm and pulmonary arterial hypertension. Clonal lineage tracing revealed that the VSMC-contribution to disease results from the hyperproliferation of few pre-existing medial cells and suggested that VSMC-derived cells from the same clone can adopt diverse phenotypes. Studies harnessing the powerful combination of lineage tracing and single-cell transcriptomics have delineated the substantial diversity of VSMC-derived cells in vascular lesions, which are proposed to have both beneficial and detrimental effects on disease severity. Computational analyses further suggest that the pathway from contractile VSMCs in healthy arteries to phenotypically distinct lesional cells consists of multiple, potentially regulatable, steps. A better understanding of how individual steps are controlled could reveal effective therapeutic strategies to minimise VSMC functions that drive pathology whilst maintaining or enhancing their beneficial roles. Here we review current knowledge of VSMC plasticity and highlight important questions that should be addressed to understand how specific stages of VSMC investment and phenotypic diversification are controlled. Implications for developing therapeutic strategies in pathological vascular remodelling are discussed and we explore how cutting-edge approaches could be used to elucidate the molecular mechanisms underlying VSMC regulation.
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Kraler S, Libby P, Evans PC, Akhmedov A, Schmiady MO, Reinehr M, Camici GG, Lüscher TF. Resilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet Needs. Arterioscler Thromb Vasc Biol 2021; 41:2237-2251. [PMID: 34107731 PMCID: PMC8299999 DOI: 10.1161/atvbaha.121.316256] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fueled by the global surge in aging, atherosclerotic cardiovascular disease reached pandemic dimensions putting affected individuals at enhanced risk of myocardial infarction, stroke, and premature death. Atherosclerosis is a systemic disease driven by a wide spectrum of factors, including cholesterol, pressure, and disturbed flow. Although all arterial beds encounter a similar atherogenic milieu, the development of atheromatous lesions occurs discontinuously across the vascular system. Indeed, the internal mammary artery possesses unique biological properties that confer protection to intimal growth and atherosclerotic plaque formation, thus making it a conduit of choice for coronary artery bypass grafting. Its endothelium abundantly expresses nitric oxide synthase and shows accentuated nitric oxide release, while its vascular smooth muscle cells exhibit reduced tissue factor expression, high tPA (tissue-type plasminogen activator) production and blunted migration and proliferation, which may collectively mitigate intimal thickening and ultimately the evolution of atheromatous plaques. We aim here to provide insights into the anatomy, physiology, cellular, and molecular aspects of the internal mammary artery thereby elucidating its remarkable resistance to atherogenesis. We propose a change in perspective from risk to resilience to decipher mechanisms of atheroresistance and eventually identification of novel therapeutic targets presently not addressed by currently available remedies.
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Affiliation(s)
- Simon Kraler
- Center for Molecular Cardiology, University of Zürich, 8952 Schlieren, Switzerland
| | - Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Paul C. Evans
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zürich, 8952 Schlieren, Switzerland
| | - Martin O. Schmiady
- Clinic for Cardiac Surgery, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Michael Reinehr
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni G. Camici
- Center for Molecular Cardiology, University of Zürich, 8952 Schlieren, Switzerland
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zürich, 8952 Schlieren, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College, London, United Kingdom
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Gao J, Zhao Z, Zhu J, Tian H, Liu Y. The Role of Color Doppler Ultrasonography in the Perioperative Period of Coronary Artery Bypass Grafting: Comparison with Transit-Time Flow Measurement. Cardiology 2021; 146:583-590. [PMID: 34192706 DOI: 10.1159/000512430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The value of color Doppler ultrasonography (CDUS) with the supraclavicular approach for preoperative evaluation of the native left internal mammary artery (LIMA) as well as for the postoperative detection of LIMA graft patency was recently suggested. However, the parameters such as the flow volume and pulsatile index (PI) have not been studied in detail. OBJECTIVES The objectives of this study were to analyze the LIMA data in the perioperative period and explore the relationships between the intraoperative graft flow with transit-time flow measurement (TTFM) and the postoperatively measured parameters with CDUS. METHODS Fifty-eight patients with significant stenosis (≥70%) or occlusions in left anterior descending artery (LAD) who were referred for isolated coronary artery bypass grafting (CABG) were enrolled in this study and examined by CDUS prior to CABG from April to July 2016. The perioperative measurements of proximal LIMA by CDUS were compared. In addition, the correlation between the intraoperative graft flow, such as the mean graft flow (MGF) and PI, and the immediate postoperative measurements of CDUS in LIMA bypassed grafts was statistically analyzed. RESULTS Six patients were excluded due to screening failure, or insufficient visualization of CDUS images for analysis. Fifty-two patients with in situ LIMA-LAD graft, with or without additional arterial grafts or saphenous vein grafts, were included in the final analysis. The postoperative diameters of proximal LIMA were not significantly different from preoperative diameters (2.21 ± 0.18 vs. 2.27 ± 0.22 mm, p = 0.070). The flow volume on the early postoperative CDUS significantly increased (39.77 ± 21.59 vs. 25.96 ± 13.17 mL/min, p < 0.001) and the PI significantly decreased (1.43 ± 0.46 vs. 4.20 ± 1.49, p < 0.001) versus those of preoperative measurements. The MGF had a moderate correlation with the flow volume on the early postoperative CDUS (r = 0.414, p = 0.002), and the PI by TTFM had a weak correlation with that by CDUS (r = 0.353, p = 0.010) as well. CONCLUSIONS The MGF and PI by TTFM in CABG were associated with in situ LIMA graft parameters measured by CDUS studies. CDUS is a useful functional noninvasive tool for the preoperative screening and postoperative follow-up of patients with in situ LIMA bypass.
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Affiliation(s)
- Junxue Gao
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Zhou Zhao
- Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China
| | - Jiaan Zhu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Hui Tian
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
| | - Yuejie Liu
- Department of Ultrasound, Peking University People's Hospital, Beijing, China
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Conduits' Biology Regulates the Outcomes of Coronary Artery Bypass Grafting. JACC Basic Transl Sci 2021; 6:388-396. [PMID: 33997524 PMCID: PMC8093468 DOI: 10.1016/j.jacbts.2020.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Accelerated atherosclerosis is common when SVGs, but not arterial grafts, are used for myocardial revascularization during CABG. This review will provide an overview of the available data on the most commonly used conduits in CABG, highlighting the differences in their cellular biology, mechanical, biochemical, and vasoconstrictive properties. Clinical and scientific evidence support the use of arterial grafts over venous conduits at the time of CABG. These arterial conduits seem to be more protected toward the development of atherosclerosis. Exploring the molecular and cellular mechanisms, of the various cell populations within these conduits, will help unveil the pathways responsible for these protective effects.
Coronary artery bypass graft (CABG) is the gold standard for coronary surgical revascularization. Retrospective, prospective, and meta-analysis studies looking into long-term outcomes of using different conduits have pointed to the superiority of arterial grafts over veins and have placed the internal mammary artery as the standard conduit of choice for CABG. The superiority of the internal mammary artery over other conduits could be attributable to its intrinsic characteristics; however, little is known regarding the features that render some conduits atherosclerosis-prone and others atherosclerosis-resistant. Here, an overview is provided of the available data on the most commonly used conduits in CABG (internal mammary artery, saphenous vein, radial artery, gastroepiploic artery), highlighting the differences in their cellular biology, mechanical, biochemical, and vasoconstrictive properties. This information should help in furthering our understanding of the clinical outcomes observed for each of these conduits.
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Marchese P, Lombardi M, Mantione ME, Baccellieri D, Ferrara D, Chiesa R, Alfieri O, Foglieni C. Confocal Blood Flow Videomicroscopy of Thrombus Formation over Human Arteries and Local Targeting of P2X7. Int J Mol Sci 2021; 22:ijms22084066. [PMID: 33920051 PMCID: PMC8071050 DOI: 10.3390/ijms22084066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
Atherothrombosis exposes vascular components to blood. Currently, new antithrombotic therapies are emerging. Herein we investigated thrombogenesis of human arteries with/without atherosclerosis, and the interaction of coagulation and vascular components, we and explored the anti-thrombogenic efficacy of blockade of the P2X purinoceptor 7 (P2X7). A confocal blood flow videomicroscopy system was performed on cryosections of internal mammary artery (IMA) or carotid plaque (CPL) determining/localizing platelets and fibrin. Blood from healthy donors elicited thrombi over arterial layers. Confocal microscopy associated thrombus with tissue presence of collagen type I, laminin, fibrin(ogen) and tissue factor (TF). The addition of antibodies blocking TF (aTF) or factor XI (aFXI) to blood significantly reduced fibrin deposition, variable platelet aggregation and aTF + aFXI almost abolished thrombus formation, showing synergy between coagulation pathways. A scarce effect of aTF over sub-endothelial regions, more abundant in tissue TF and bundles of laminin and collagen type I than deep intima, may suggest tissue thrombogenicity as molecular structure-related. Consistently with TF-related vascular function and expression of P2X7, the sections from CPL but not IMA tissue cultures pre-treated with the P2X7 antagonist A740003 demonstrated poor thrombogenesis in flow experiments. These data hint to local targeting studies on P2X7 modulation for atherothrombosis prevention/therapy.
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Affiliation(s)
- Patrizia Marchese
- Department of Immunology and Microbiology, Scripps Research, La Jolla, CA 92037, USA;
| | - Maria Lombardi
- Myocardial Diseases and Atherosclerosis Unit, Cardiovascular Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (M.L.); (M.E.M.)
| | - Maria Elena Mantione
- Myocardial Diseases and Atherosclerosis Unit, Cardiovascular Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (M.L.); (M.E.M.)
| | - Domenico Baccellieri
- Cardiothoracic and Vascular Department, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (D.B.); (D.F.); (R.C.); (O.A.)
| | - David Ferrara
- Cardiothoracic and Vascular Department, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (D.B.); (D.F.); (R.C.); (O.A.)
| | - Roberto Chiesa
- Cardiothoracic and Vascular Department, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (D.B.); (D.F.); (R.C.); (O.A.)
| | - Ottavio Alfieri
- Cardiothoracic and Vascular Department, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (D.B.); (D.F.); (R.C.); (O.A.)
| | - Chiara Foglieni
- Myocardial Diseases and Atherosclerosis Unit, Cardiovascular Research Center, San Raffaele Scientific Institute IRCCS, Via Olgettina, 58, 20132 Milano, Italy; (M.L.); (M.E.M.)
- Correspondence: ; Tel.: +39-02-26434570
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Mikami T, Furuhashi M, Sakai A, Numaguchi R, Harada R, Naraoka S, Kamada T, Higashiura Y, Tanaka M, Ohori S, Sakurada T, Nakamura M, Iba Y, Fukada J, Miura T, Kawaharada N. Antiatherosclerotic Phenotype of Perivascular Adipose Tissue Surrounding the Saphenous Vein in Coronary Artery Bypass Grafting. J Am Heart Assoc 2021; 10:e018905. [PMID: 33779243 PMCID: PMC8174366 DOI: 10.1161/jaha.120.018905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Perivascular adipose tissue (PVAT) is associated with metabolically driven chronic inflammation called metaflammation, which contributes to vascular function and the pathogenesis of vascular disease. The saphenous vein (SV) is commonly used as an essential conduit in coronary artery bypass grafting, but the long‐term patency of SV grafts is a crucial issue. The use of the novel “no‐touch” technique of SV harvesting together with its surrounding tissue has been reported to result in good long‑term graft patency of SV grafts. Herein, we investigated whether PVAT surrounding the SV (SV‐PVAT) has distinct phenotypes compared with other PVATs of vessels. Methods and Results Fat pads were sampled from 48 patients (male/female, 32/16; age, 72±8 years) with coronary artery disease who underwent elective coronary artery bypass grafting. Adipocyte size in SV‐PVAT was significantly larger than the sizes in PVATs surrounding the internal thoracic artery, coronary artery, and aorta. SV‐PVAT and PVAT surrounding the internal thoracic artery had smaller extents of fibrosis, decreased gene expression levels of fibrosis‐related markers, and less metaflammation, as indicated by a significantly smaller extent of cluster of differentiation 11c–positive M1 macrophage infiltration, higher gene expression level of adiponectin, and lower gene expression levels of inflammatory cytokines, than did PVATs surrounding the coronary artery and aorta. Expression patterns of adipocyte developmental and pattern‐forming genes were totally different among the PVATs of the vessels. Conclusions The phenotype of SV‐PVAT, which may result from inherent differences in adipocytes, is closer to that of PVAT surrounding the internal thoracic artery than that of PVAT surrounding the coronary artery or that of PVAT surrounding the aorta. SV‐PVAT has less metaflammation and consecutive adipose tissue remodeling, which may contribute to high long‐term patency of grafting when the no‐touch technique of SV harvesting is used.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Akiko Sakai
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryosuke Numaguchi
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Yukimura Higashiura
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Shunsuke Ohori
- Department of Cardiovascular Surgery Hokkaido Ohno Memorial Hospital Sapporo Japan
| | - Taku Sakurada
- Department of Cardiovascular Surgery Sapporo Central Hospital Sapporo Japan
| | - Masanori Nakamura
- Department of Cardiovascular Surgery Sapporo City General Hospital Sapporo Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery Teine Keijinkai Hospital Sapporo Japan
| | - Joji Fukada
- Department of Cardiovascular Surgery Otaru City General Hospital Otaru Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
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McNichols B, Spratt JR, George J, Rizzi S, Manning EW, Park K. Coronary Artery Bypass: Review of Surgical Techniques and Impact on Long-Term Revascularization Outcomes. Cardiol Ther 2021; 10:89-109. [PMID: 33515370 PMCID: PMC8126527 DOI: 10.1007/s40119-021-00211-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Coronary revascularization for multivessel disease remains a common and costly source of hospitalizations in the United States. Surgical techniques influence outcomes for coronary bypass and also affect the need for percutaneous coronary intervention in the future. As more radial access has been used for coronary angiography, consideration for use of the radial artery as a surgical conduit remains unclear. Saphenous vein grafts are commonly used for coronary bypass, however long-term patency remains suboptimal, and is also associated with a higher risk of adverse events with percutaneous coronary intervention. Thus, understanding the interplay between coronary bypass techniques and percutaneous coronary intervention has become increasingly important.
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Affiliation(s)
- Brian McNichols
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - John R Spratt
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jerin George
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Scott Rizzi
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Eddie W Manning
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ki Park
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
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Calciprotein Particles Cause Endothelial Dysfunction under Flow. Int J Mol Sci 2020; 21:ijms21228802. [PMID: 33233811 PMCID: PMC7699979 DOI: 10.3390/ijms21228802] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 12/20/2022] Open
Abstract
Calciprotein particles (CPPs), which increasingly arise in the circulation during the disorders of mineral homeostasis, represent a double-edged sword protecting the human organism from extraskeletal calcification but potentially causing endothelial dysfunction. Existing models, however, failed to demonstrate the detrimental action of CPPs on endothelial cells (ECs) under flow. Here, we applied a flow culture system, where human arterial ECs were co-incubated with CPPs for 4 h, and a normolipidemic and normotensive rat model (10 daily intravenous injections of CPPs) to simulate the scenario occurring in vivo in the absence of confounding cardiovascular risk factors. Pathogenic effects of CPPs were investigated by RT-qPCR and Western blotting profiling of the endothelial lysate. CPPs were internalised within 1 h of circulation, inducing adhesion of peripheral blood mononuclear cells to ECs. Molecular profiling revealed that CPPs stimulated the expression of pro-inflammatory cell adhesion molecules VCAM1 and ICAM1 and upregulated transcription factors of endothelial-to-mesenchymal transition (Snail, Slug and Twist1). Furthermore, exposure to CPPs reduced the production of atheroprotective transcription factors KLF2 and KLF4 and led to YAP1 hypophosphorylation, potentially disturbing the mechanisms responsible for the proper endothelial mechanotransduction. Taken together, our results suggest the ability of CPPs to initiate endothelial dysfunction at physiological flow conditions.
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Rai P, Taylor R, Bittar MN. Long-term survival in patients who had CABG with or without prior coronary artery stenting. Open Heart 2020; 7:openhrt-2019-001160. [PMID: 33168639 PMCID: PMC7654116 DOI: 10.1136/openhrt-2019-001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/29/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To conduct a large-scale, single-centre retrospective cohort study to understand the impact of prior percutaneous coronary intervention (PCI) on long-term survival of patients who then undergo coronary artery bypass graft (CABG). Methods Between 1999 and 2017, a total of 11 332 patients underwent CABG at a hospital in the UK. The patients were stratified into those who received PCI (n=1090) or no PCI (n=10 242) prior to CABG. A total of 1058 patients from each group were matched using propensity score matching. Kaplan-Meier estimates were used to assess risk-adjusted survival in patients with prior PCI. Cox proportional hazards (CoxPH) model was then used to assess the effect of prior PCI and other variables in patients undergoing CABG. Results The immediate postoperative outcome showed no difference in number of grafts per patients, blood transfusion, hospital stay or 30 days mortality between the groups. There was no significant difference in 5 years (90.8% vs 87.9), 10-year (76.5% vs 74.6%) and 15-year (64.4% vs 64.7%) survival between the non-PCI versus PCI groups. The Cox proportional hazards model further supports the null hypothesis as the PCI variable was found to be non-significant (CoxPH=1.03, p=0.75, CI=0.87–1.22) implying there was no difference in hazard of death for CABG patients with or without previous PCI. However, the model did yield information on the covariates that do affect the hazard of death. Conclusion There is no difference in 5-year, 10-year and 15-year survival between patients undergoing CABG with or without prior PCI. However, certain patient, preoperative and intraoperative risk factors were identified with high hazard of death which needs to be investigated further.
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Affiliation(s)
- Pratik Rai
- Department of Cardiothoracic Surgery, Lancanshire Cardiac Center, Blackpool Victoria Hospital, Blackpool, UK
| | - Rebecca Taylor
- Department of Cardiothoracic Surgery, Lancanshire Cardiac Center, Blackpool Victoria Hospital, Blackpool, UK
| | - Mohamad Nidal Bittar
- Department of Cardiothoracic Surgery, Lancanshire Cardiac Center, Blackpool Victoria Hospital, Blackpool, UK
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Co-Culture of Primary Human Coronary Artery and Internal Thoracic Artery Endothelial Cells Results in Mutually Beneficial Paracrine Interactions. Int J Mol Sci 2020; 21:ijms21218032. [PMID: 33126651 PMCID: PMC7663246 DOI: 10.3390/ijms21218032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
Although saphenous veins (SVs) are commonly used as conduits for coronary artery bypass grafting (CABG), internal thoracic artery (ITA) grafts have significantly higher long-term patency. As SVs and ITA endothelial cells (ECs) have a considerable level of heterogeneity, we suggested that synergistic paracrine interactions between CA and ITA ECs (HCAECs and HITAECs, respectively) may explain the increased resistance of ITA grafts and adjacent CAs to atherosclerosis and restenosis. In this study, we measured the gene and protein expression of the molecules responsible for endothelial homeostasis, pro-inflammatory response, and endothelial-to-mesenchymal transition in HCAECs co-cultured with either HITAECs or SV ECs (HSaVECs) for an ascending duration. Upon the co-culture, HCAECs and HITAECs showed augmented expression of endothelial nitric oxide synthase (eNOS) and reduced expression of endothelial-to-mesenchymal transition transcription factors Snail and Slug when compared to the HCAEC–HSaVEC model. HCAECs co-cultured with HITAECs demonstrated an upregulation of HES1, a master regulator of arterial specification, of which the expression was also exclusively induced in HSaVECs co-cultured with HCAECs, suggestive of their arterialisation. In addition, co-culture of HCAECs and HITAECs promoted the release of pro-angiogenic molecules. To conclude, co-culture of HCAECs and HITAECs results in reciprocal and beneficial paracrine interactions that might contribute to the better performance of ITA grafts upon CABG.
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Komarov RN, Ismailbayev AM, Kadyraliyev BK, Zhigalov KY. [Complete myocardial revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts for coronary artery bypass surgery]. Khirurgiia (Mosk) 2020:109-115. [PMID: 33030011 DOI: 10.17116/hirurgia2020091109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Complete revascularization in patients with multiple-vessel coronary artery disease and partial or complete absence of the grafts is still actual problem for cardiac surgeons. The main causes of the absence of conduits for coronary artery bypass surgery are aging of population, increased incidence of repeated coronary artery bypass surgery and prevalence of varicose vein disease of the lower extremities. The most perspective approaches characterized by acceptable early and long-term postoperative outcomes are bilateral internal mammary artery grafting, sequential bypass including autoarterial grafts, as well as hybrid revascularization methods. However, treatment strategy is individualized in each patient.
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Affiliation(s)
- R N Komarov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A M Ismailbayev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - B K Kadyraliyev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - K Yu Zhigalov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Nanthakumar H, Iwanaga J, Dumont AS, Tubbs RS. A rare cadaveric case of a duplicated internal thoracic artery. Anat Cell Biol 2020; 53:366-368. [PMID: 32727954 DOI: 10.5115/acb.20.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/20/2020] [Accepted: 06/05/2020] [Indexed: 11/27/2022] Open
Abstract
The internal thoracic artery (ITA) arises from the subclavian artery and terminates as the musculophrenic and inferior epigastric arteries. During routine cadaveric dissection, an aberrant left ITA was discovered. A medial and a lateral branch of the ITA branched directly off the subclavian artery as opposed to bifurcating at the 6th or 7th intercostal space. To our knowledge, this is the first reported case of this particular ITA variation arising from the third part of the subclavian artery. Additionally, such a variant might also be considered a high bifurcation of the ITA. Our report examines this variation and its potential implications for coronary artery bypass grafts where the ITA is commonly used.
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Affiliation(s)
- Harry Nanthakumar
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
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Nanthakumar H, Iwanaga J, Dumont AS, Tubbs RS. A rare cadaveric case of a duplicated internal thoracic artery. Anat Cell Biol 2020; 53. [PMID: 32727954 PMCID: PMC7527130 DOI: 10.25373/ctsnet.7611560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The internal thoracic artery (ITA) arises from the subclavian artery and terminates as the musculophrenic and inferior epigastric arteries. During routine cadaveric dissection, an aberrant left ITA was discovered. A medial and a lateral branch of the ITA branched directly off the subclavian artery as opposed to bifurcating at the 6th or 7th intercostal space. To our knowledge, this is the first reported case of this particular ITA variation arising from the third part of the subclavian artery. Additionally, such a variant might also be considered a high bifurcation of the ITA. Our report examines this variation and its potential implications for coronary artery bypass grafts where the ITA is commonly used.
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Affiliation(s)
- Harry Nanthakumar
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA,Corresponding author: Joe Iwanaga Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA E-mail:
| | - Aaron S. Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R. Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA,Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA,Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, West Indies
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38
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Khan Y, Shahabuddin S, Hashmi S, Sami S. Comparing Outcomes in Patients Undergoing Coronary Artery Bypass Grafting With and Without Using the Internal Mammary Artery in a Tertiary Care Hospital. Cureus 2020; 12:e10427. [PMID: 33062540 PMCID: PMC7553791 DOI: 10.7759/cureus.10427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The left internal mammary artery in coronary artery bypass grafting (CABG) is considered to be an important intraoperative quality indicator with excellent long-term results. The purpose of this study is to compare the early outcomes of CABG with and without the left internal mammary artery (LIMA) in the South Asian population and to look for the utilization of LIMA as per the recommendations of the Society of Thoracic Surgeons in a developing country. Materials and methods A retrospective review was carried out for all patients who underwent CABG from 2010 to 2015. Patients were divided into two groups on the basis of whether LIMA was used (Group I) or not used (Group II) as a conduit. Both groups were further subdivided into elective and urgent. Preoperative, intraoperative, and postoperative variables were recorded and compared. Results After exclusion, a total of 2619 patients underwent isolated CABG surgery during the required duration. The LIMA was used in 94% of the patients (n=2472) while 147 patients underwent CABG without LIMA. The use of LIMA was associated with significantly lower mortality (2% LIMA vs 8.8% no LIMA), as well as a decrease in major comorbidity, stroke, and prolonged ventilation. In the subgroup analysis, LIMA usage in elective and urgent cases was associated with significantly lower mortality (elective 1.6% LIMA vs 7.4% No LIMA) (urgent 4.8% LIMA vs 15.7 % no LIMA)) and major morbidity. Conclusion The outcomes of CABG procedures without LIMA were not encouraging. Our results support compliance with standard adult cardiac surgery quality-of-care guidelines.
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Affiliation(s)
- Yasir Khan
- Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, PAK
| | | | - Shiraz Hashmi
- Cardiothoracic Surgery, Aga Khan University, Karachi, PAK
| | - Shahid Sami
- Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, PAK
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Radiation-Induced Left Main Coronary Artery Stenosis in a Patient with Atretic Internal Mammary Arteries. Case Rep Cardiol 2020; 2020:7970305. [PMID: 32455030 PMCID: PMC7238366 DOI: 10.1155/2020/7970305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/29/2020] [Indexed: 11/18/2022] Open
Abstract
Coronary artery disease (CAD) is a known potential complication of thoracic radiation treatment that typically affects the proximal segments of the coronary arteries, requiring coronary artery bypass grafting (CABG). We present a case of acute coronary syndrome occurring in a 57-year-old man with prior thoracic radiation therapy following resection of a chest wall chondrosarcoma. Coronary angiogram demonstrated significant areas of stenosis in the left main coronary artery (LMCA) and ostial left anterior descending (LAD) coronary artery. The patient was also found to have atretic bilateral internal mammary arteries as a consequence of his radiation therapy, rendering them unsuitable as grafts. Percutaneous coronary intervention (PCI) was thus performed with a successful outcome. To our knowledge, this is the first case of radiation-induced CAD of the LMCA with atretic internal mammary arteries treated successfully with PCI.
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Numaguchi R, Furuhashi M, Matsumoto M, Sato H, Yanase Y, Kuroda Y, Harada R, Ito T, Higashiura Y, Koyama M, Tanaka M, Moniwa N, Nakamura M, Doi H, Miura T, Kawaharada N. Differential Phenotypes in Perivascular Adipose Tissue Surrounding the Internal Thoracic Artery and Diseased Coronary Artery. J Am Heart Assoc 2020; 8:e011147. [PMID: 30638109 PMCID: PMC6497339 DOI: 10.1161/jaha.118.011147] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Perivascular adipose tissue (PVAT) is causally associated with vascular function and the pathogenesis of vascular disease in association with metabolically driven chronic inflammation called metaflammation. However, the difference in PVAT surrounding the coronary artery (CA‐PVAT) and that surrounding the internal thoracic artery (ITA‐PVAT), a vessel resistant to atherosclerosis, remains unclear. Herein, we investigated whether CA‐PVAT, ITA‐PVAT, and subcutaneous adipose tissue (SCAT) have distinct phenotypes. Methods and Results Fat pads were sampled from 44 patients (men/women, 36:8; age, 67±13 years) with CA disease who underwent elective CA bypass grafting. Adipocyte size in ITA‐PVAT and that in CA‐PVAT were significantly smaller than that in SCAT. A greater extent of fibrosis and increased gene expression levels of fibrosis‐related molecules were observed in CA‐PVAT than those in SCAT and those in ITA‐PVAT. CA‐PVAT exhibited more pronounced metaflammation, as indicated by a significantly larger extent of CD68‐positive and CD11c‐positive M1 macrophages, a lower ratio of CD206‐positive M2 to CD11c‐positive M1 macrophages, a lower gene expression level of adiponectin, and higher gene expression levels of inflammatory cytokines and inflammasome‐ and endoplasmic reticulum stress–related molecules, than did ITA‐PVAT and SCAT. Expression patterns of adipocyte developmental and pattern‐forming genes were totally different among SCAT, ITA‐PVAT, and CA‐PVAT. Conclusions The phenotype of ITA‐PVAT is closer to that of SCAT than that of CA‐PVAT, which may result from inherent differences in adipocytes. ITA‐PVAT appears to be protected from metaflammation and consecutive adipose tissue remodeling, which may contribute to the decreased atherosclerotic plaque burden in the ITA.
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Affiliation(s)
- Ryosuke Numaguchi
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Masato Furuhashi
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Megumi Matsumoto
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Hiroshi Sato
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Yosuke Yanase
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Yosuke Kuroda
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Ryo Harada
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Toshiro Ito
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
| | - Yukimura Higashiura
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Masayuki Koyama
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Marenao Tanaka
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Norihito Moniwa
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Masanori Nakamura
- 3 Department of Cardiovascular Surgery Sapporo City General Hospital Sapporo Japan
| | - Hirosato Doi
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan.,4 Department of Cardiovascular Surgery Sapporo Cardiovascular Clinic Sapporo Japan
| | - Tetsuji Miura
- 2 Department of Cardiovascular, Renal and Metabolic Medicine Sapporo Medical University School of Medicine Sapporo Japan
| | - Nobuyoshi Kawaharada
- 1 Department of Cardiovascular Surgery Sapporo Medical University School of Medicine Sapporo Japan
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Kleefeldt F, Bömmel H, Broede B, Thomsen M, Pfeiffer V, Wörsdörfer P, Karnati S, Wagner N, Rueckschloss U, Ergün S. Aging-related carcinoembryonic antigen-related cell adhesion molecule 1 signaling promotes vascular dysfunction. Aging Cell 2019; 18:e13025. [PMID: 31389127 PMCID: PMC6826129 DOI: 10.1111/acel.13025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/03/2019] [Accepted: 06/23/2019] [Indexed: 01/03/2023] Open
Abstract
Aging is an independent risk factor for cardiovascular diseases and therefore of particular interest for the prevention of cardiovascular events. However, the mechanisms underlying vascular aging are not well understood. Since carcinoembryonic antigen‐related cell adhesion molecule 1 (CEACAM1) is crucially involved in vascular homeostasis, we sought to identify the role of CEACAM1 in vascular aging. Using human internal thoracic artery and murine aorta, we show that CEACAM1 is upregulated in the course of vascular aging. Further analyses demonstrated that TNF‐α is CEACAM1‐dependently upregulated in the aging vasculature. Vice versa, TNF‐α induces CEACAM1 expression. This results in a feed‐forward loop in the aging vasculature that maintains a chronic pro‐inflammatory milieu. Furthermore, we demonstrate that age‐associated vascular alterations, that is, increased oxidative stress and vascular fibrosis, due to increased medial collagen deposition crucially depend on the presence of CEACAM1. Additionally, age‐dependent upregulation of vascular CEACAM1 expression contributes to endothelial barrier impairment, putatively via increased VEGF/VEGFR‐2 signaling. Consequently, aging‐related upregulation of vascular CEACAM1 expression results in endothelial dysfunction that may promote atherosclerotic plaque formation in the presence of additional risk factors. Our data suggest that CEACAM1 might represent an attractive target in order to delay physiological aging and therefore the transition to vascular disorders such as atherosclerosis.
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Affiliation(s)
- Florian Kleefeldt
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Heike Bömmel
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Britta Broede
- Leonardo Hirslanden Clinic Birshof Münchenstein Switzerland
| | | | - Verena Pfeiffer
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Philipp Wörsdörfer
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Srikanth Karnati
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Nicole Wagner
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Uwe Rueckschloss
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
| | - Süleyman Ergün
- Institute of Anatomy and Cell Biology Julius‐Maximilians‐University Würzburg Würzburg Germany
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Nandal S, Narayan O, Barlis P, Ponnuthurai FA. Management of atherosclerotic plaque in left internal mammary artery graft five years after angiographic patency: A case report. World J Cardiol 2019; 11:277-281. [PMID: 31798794 PMCID: PMC6885449 DOI: 10.4330/wjc.v11.i11.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/09/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The left internal mammary artery (LIMA) has demonstrated excellent long-term patency rates when used as a bypass conduit with complications usually occurring in the early postoperative period. The rapid development of de-novo atherosclerosis in a previously non-diseased LIMA, subsequently leading to an acute coronary syndrome (ACS) is rarely encountered.
CASE SUMMARY A 67-year-old man with history of triple coronary artery bypass graft (8 years ago) presented to our hospital with an ACS. He had undergone angiography 5 years ago to investigate episodic chest pain and imaging of the LIMA at the time did not demonstrate the atherosclerotic process. Emergent angiography demonstrated a severe diffuse stenosis in the proximal to mid segment of the LIMA, with embolization of a moderate sized thrombus to the distal skip segment. The LIMA stenosis was characterised by overlying haziness, consistent with acute plaque rupture, associated with residual luminal thrombus. The patient was managed with antithrombotic therapy to reduce the thrombus burden until repeat angiography after 72 h. At repeat angiography, the thrombus burden was substantially reduced at the distal skip segment as well as at the proximal to mid LIMA with the demonstration of multiple plaque cavities. This lesion was predilated and a 2.75 mm × 33 mm everolimus-eluting stent was implanted to a final diameter of 3.0 mm. The patient made a good clinical recovery and was discharged after 6 d.
CONCLUSION This case highlights the rapid and late development of atherosclerosis in a graft 5 years after documented patency and the importance for consideration of expectant thrombus management.
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Affiliation(s)
- Savvy Nandal
- Department of Cardiology, The Northern Hospital, Epping, Victoria 3076, Australia
| | - Om Narayan
- Department of Cardiology, The Northern Hospital, Epping, Victoria 3076, Australia
| | - Peter Barlis
- Department of Cardiology, The Northern Hospital, Epping, Victoria 3076, Australia
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Allahverdian S, Chaabane C, Boukais K, Francis GA, Bochaton-Piallat ML. Smooth muscle cell fate and plasticity in atherosclerosis. Cardiovasc Res 2019; 114:540-550. [PMID: 29385543 DOI: 10.1093/cvr/cvy022] [Citation(s) in RCA: 306] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/22/2018] [Indexed: 12/21/2022] Open
Abstract
Current knowledge suggests that intimal smooth muscle cells (SMCs) in native atherosclerotic plaque derive mainly from the medial arterial layer. During this process, SMCs undergo complex structural and functional changes giving rise to a broad spectrum of phenotypes. Classically, intimal SMCs are described as dedifferentiated/synthetic SMCs, a phenotype characterized by reduced expression of contractile proteins. Intimal SMCs are considered to have a beneficial role by contributing to the fibrous cap and thereby stabilizing atherosclerotic plaque. However, intimal SMCs can lose their properties to such an extent that they become hard to identify, contribute significantly to the foam cell population, and acquire inflammatory-like cell features. This review highlights mechanisms of SMC plasticity in different stages of native atherosclerotic plaque formation, their potential for monoclonal or oligoclonal expansion, as well as recent findings demonstrating the underestimated deleterious role of SMCs in this disease.
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Affiliation(s)
- Sima Allahverdian
- Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Room 166 Burrard Building, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Chiraz Chaabane
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel Servet-1, 1211 Geneva 4, Switzerland
| | - Kamel Boukais
- Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Room 166 Burrard Building, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Gordon A Francis
- Department of Medicine, Centre for Heart Lung Innovation, Providence Health Care Research Institute, University of British Columbia, Room 166 Burrard Building, St Paul's Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Marie-Luce Bochaton-Piallat
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Rue Michel Servet-1, 1211 Geneva 4, Switzerland
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Increased Lymphangiogenesis and Lymphangiogenic Growth Factor Expression in Perivascular Adipose Tissue of Patients with Coronary Artery Disease. J Clin Med 2019; 8:jcm8071000. [PMID: 31324038 PMCID: PMC6678243 DOI: 10.3390/jcm8071000] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/17/2022] Open
Abstract
Experimental and human autopsy studies have associated adventitial lymphangiogenesis with atherosclerosis. An analysis of perivascular lymphangiogenesis in patients with coronary artery disease is lacking. Here, we examined lymphangiogenesis and its potential regulators in perivascular adipose tissue (PVAT) surrounding the heart (C-PVAT) and compared it with PVAT of the internal mammary artery (IMA-PVAT). Forty-six patients undergoing coronary artery bypass graft surgery were included. Perioperatively collected C-PVAT and IMA-PVAT were analyzed using histology, immunohistochemistry, real time PCR, and PVAT-conditioned medium using cytokine arrays. C-PVAT exhibited increased PECAM-1 (platelet endothelial cell adhesion molecule 1)-positive vessel density. The number of lymphatic vessels expressing lymphatic vessel endothelial hyaluronan receptor-1 or podoplanin was also elevated in C-PVAT and associated with higher inflammatory cell numbers, increased intercellular adhesion molecule 1 (ICAM1) expression, and fibrosis. Significantly higher expression of regulators of lymphangiogenesis such as vascular endothelial growth factor (VEGF)-C, VEGF-D, and VEGF receptor-3 was observed in C-PVAT compared to IMA-PVAT. Cytokine arrays identified angiopoietin-2 as more highly expressed in C-PVAT vs. IMA-PVAT. Findings were confirmed histologically and at the mRNA level. Stimulation of human lymphatic endothelial cells with recombinant angiopoietin-2 in combination with VEGF-C enhanced sprout formation. Our study shows that PVAT surrounding atherosclerotic arteries exhibits more extensive lymphangiogenesis, inflammation, and fibrosis compared to PVAT surrounding a non-diseased vessel, possibly due to local angiopoietin-2, VEGF-C, and VEGF-D overexpression.
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Long-term graft patency after coronary artery bypass grafting: Effects of morphological and pathophysiological factors. Anatol J Cardiol 2019; 20:275-282. [PMID: 30391966 PMCID: PMC6280286 DOI: 10.14744/anatoljcardiol.2018.51447] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The aim of the present study was to identify morphological and pathophysiological factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). METHODS A total of 127 patients who underwent CABG between 2000 and 2006 and presented for computed tomography evaluation of graft patency at 139.78±36.64 months post-CABG were analyzed. Patients received 340 grafts (2.68 grafts/patient), 399 distal anastomoses (3.14 anastomoses/ patient), 220 (55.14%) performed using arterial grafts, and 179 (44.86%) using saphenous vein grafts (SVGs). RESULTS Graft patency varied according to vessel type and coronary territory. Overall graft patency was 90.16% for the left internal thoracic artery (LITA), 75.55% for the right internal thoracic artery (RITA), 79.25% for the radial artery (RA), and 74.3% for the SVG. The maximum patency rate was obtained with the RA (80.65%) for the right coronary territory, RITA (92.86%) for the anterolateral territory, and SVG (82.54%) for the circumflex territory. The LITA-left anterior descending artery graft occluded in 13 (7.93%) cases, 7 due to competitive flow. The influence of graft length on patency rates after indexing to height was not significant. The target vessel degree of stenosis influenced arterial graft patency rates with an occlusion odds ratio (OR) of 3.02 when anastomosed to target vessels with <90% stenosis. Target vessel caliber also influenced patency rates with occlusion ORs of 2.63 for SVGs and 2.31 for arterial grafts when anastomosed to ≤1.5 mm target vessels. CONCLUSION Morphological parameters, such as graft type, target territory, target vessel caliber, and degree of stenosis, are important factors conditioning long-term graft patency.
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Tassopoulos A, Didagelos M, Tsiafoutis I, Ziakas A, Koutouzis M. Percutaneous coronary intervention for distal coronary graft anastomosis le-sions: a case series. Hippokratia 2019; 23:87-91. [PMID: 32265590 PMCID: PMC7127916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Management of coronary artery graft failure, especially at the site of a recent distal anastomosis, is a challenging clinical situation, and literature data are scarce. CASE SERIES We present a case series of patients with coronary artery bypass graft failure up to six months after surgical revascularization, who were treated with percutaneous coronary intervention at the site of distal graft anastomosis through the graft or the native vessel. CONCLUSIONS Percutaneous coronary intervention at distal graft anastomotic lesions is challenging, it can be performed from either the graft or the native vessel, and the angiographic result may not always be optimal. HIPPOKRATIA 2019, 23(2): 87-91.
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Affiliation(s)
- A Tassopoulos
- Department of Cardiology, Red Cross General Hospital, Athens, Greece
| | - M Didagelos
- 1 Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - I Tsiafoutis
- Department of Cardiology, Red Cross General Hospital, Athens, Greece
| | - A Ziakas
- 1 Cardiology Department, AHEPA General Hospital, Aristotle University of Thessaloniki, Greece
| | - M Koutouzis
- Department of Cardiology, Red Cross General Hospital, Athens, Greece
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47
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Intimal regeneration after coronary endarterectomy and onlay grafting in coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2019; 67:677-683. [PMID: 30790237 DOI: 10.1007/s11748-019-01083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Coronary onlay grafting, with or without endarterectomy, has been widely used for the treatment of diffuse lesions. Recent studies have demonstrated excellent long-term patency and favorable remodeling of onlay anastomosis; however, the underlying mechanisms remain unknown. Here, we describe the mechanism of intimal regeneration based on postmortem pathological evaluation of a patient who had undergone onlay grafting with coronary endarterectomy. METHODS The onlay anastomosis was analyzed using a combination of immunohistological stainings, namely, H&E, vimentin, α-SMA, factor VIII, and Ki-67, to identify the source and mechanism of intimal regeneration after onlay grafting with endarterectomy. RESULTS Our results suggest that the regenerated endothelium derives from the smooth muscle cells of the endarterectomized media of the coronary artery and that it circumferentially covers the internal lumen of the arterial graft. CONCLUSIONS Intimal regeneration, derived from the smooth muscle cells of the endarterectomized coronary artery that proliferate toward the graft lumen, may be a key mechanism that underlies the observed favorable remodeling after onlay grafting during coronary endarterectomy.
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Pradhan A, Gupta V, Bhandari M, Vishwakarma P, Sethi R. Post Coronary Artery Bypass Grafting Failure-Don't Always Blame the Blues!! CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619828711. [PMID: 30792581 PMCID: PMC6376548 DOI: 10.1177/1179547619828711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/14/2019] [Indexed: 02/05/2023]
Abstract
Long term outcomes following coronary artery bypass grafting are governed by patency of vascular grafts. In this regard, the use of arterial grafts, (preferably the left internal mammary artery) has demonstrated improved survival relative to venous their counterparts. These benefits are a consequence of greater patency of LIMA at 10 years vis-a-vis venous grafts.Howevr, uncommonly there is a possibility of occlusion of LIMA early in the post operative period due to proecudral reasons.We report an unusual case of late occlusion of LIMA after seven years of CABG.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Vikas Gupta
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, India
| | | | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
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Bartoli-Leonard F, Wilkinson FL, Schiro A, Inglott FS, Alexander MY, Weston R. Suppression of SIRT1 in Diabetic Conditions Induces Osteogenic Differentiation of Human Vascular Smooth Muscle Cells via RUNX2 Signalling. Sci Rep 2019; 9:878. [PMID: 30696833 PMCID: PMC6351547 DOI: 10.1038/s41598-018-37027-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022] Open
Abstract
Vascular calcification is associated with significant morbidity and mortality within diabetes, involving activation of osteogenic regulators and transcription factors. Recent evidence demonstrates the beneficial role of Sirtuin 1 (SIRT1), an NAD+ dependant deacetylase, in improved insulin sensitivity and glucose homeostasis, linking hyperglycaemia and SIRT1 downregulation. This study aimed to determine the role of SIRT1 in vascular smooth muscle cell (vSMC) calcification within the diabetic environment. An 80% reduction in SIRT1 levels was observed in patients with diabetes, both in serum and the arterial smooth muscle layer, whilst both RUNX2 and Osteocalcin levels were elevated. Human vSMCs exposed to hyperglycaemic conditions in vitro demonstrated enhanced calcification, which was positively associated with the induction of cellular senescence, verified by senescence-associated β-galactosidase activity and cell cycle markers p16 and p21. Activation of SIRT1 by SRT1720 reduced Alizarin red staining by a third, via inhibition of the RUNX2 pathway and prevention of senescence. Conversely, inhibition of SIRT1 via Sirtinol and siRNA increased RUNX2 by over 50%. These findings demonstrate the key role that SIRT1 plays in preventing calcification in a diabetic environment, through the inhibition of RUNX2 and senescence pathways, suggesting a downregulation of SIRT1 may be responsible for perpetuating vascular calcification in diabetes.
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Affiliation(s)
- F Bartoli-Leonard
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - F L Wilkinson
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - A Schiro
- Vascular Unit, Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - F Serracino Inglott
- Vascular Unit, Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Y Alexander
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK
| | - R Weston
- Translational Cardiovascular Science, Centre for Bioscience, Manchester Metropolitan University, Manchester, UK.
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Histomorphometric analysis of the human internal thoracic artery and relationship with cardiovascular risk factors. PLoS One 2019; 14:e0211421. [PMID: 30682154 PMCID: PMC6347214 DOI: 10.1371/journal.pone.0211421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022] Open
Abstract
In this study, we aimed at performing a histomorphometric analysis of human left internal thoracic artery (ITA) samples as well as at correlating the histomorphometric findings with the clinical profile, including risk factors and medication. Distal segments of ITA were obtained from 54 patients undergoing coronary artery bypass grafting. Histological observation was performed in paraffin-embedded transverse sections of ITA through four staining protocols: hematoxylin-eosin, van Gieson, Masson’s trichrome and von Kossa. Morphometric analysis included the intimal width (IW), medial width (MW) and intima/media ratio (IMR). No overt atherosclerotic lesions were observed. Mild calcifications were observed across the vascular wall layers in almost all samples. Multivariable linear regression analysis showed associations between IW and IMR and the following clinical variables: age, gender, kidney function expressed as eGFR and myocardial infarction history. Age (odds ratio = 1.16, P = 0.004), female gender (odds ratio = 11.34, P = 0.011), eGFR (odds ratio = 1.03, P = 0.059) and myocardial infarction history (odds ratio = 4.81, P = 0.040) were identified as the main clinical predictors for intimal hyperplasia. Preatherosclerotic lesions in ITA samples from patients undergoing coronary revascularization were associated not only with classical cardiovascular risk factors such as age and gender, but also with other clinical variables, namely kidney function and myocardial infarction history.
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