Preservation solutions to improve graft patency: The devil is in the detail
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(2020) 15:228
LETTER TO THE EDITOR
Open Access
Preservation solutions to improve graft patency: The devil is in the detail Etem Caliskan1,2, Catherine J. Pachuk3, Louis P. Perrault4 and Maximilian Y. Emmert1,2* We read with great interest the article by Fourquet and colleagues exploring whether autologous heparinized blood (AHB), heparinized saline (HS) and GALA (considered as their reference solution) have a protective effect on vein grafts interposed in the arterial position at 6 weeks post grafting in a syngeneic rat model [1]. The authors report significant intimal hyperplasia irrespective of treatment and further describe an endothelialremodeling layer associated with an increase in wall thickness in each group at 6 weeks of follow-up. Based on these findings, they conclude that the storage solutions used in their experimental model lead to graft injury and that their reference solution (GALA) did not reduce risk of intimal hyperplasia. The study addresses an important topic and the experimental set up is interesting. However, there are several findings and conclusions that should be taken with caution and need further clarification. First, we would like to point out that the solution used in the present study and referred to as GALA neither has the same composition as the GALA solution which was developed and used at the Veterans Affairs laboratories in Boston [2] nor is it comparable to the currently commercially available DuraGraft [3, 4]. In fact, it is to be recognized that the solution used by Fourquet and colleagues has an 11.4 mM ascorbic acid concentration which is 23-fold higher than the 0.5 mM ascorbic acid concentration used in the GALA solution or DuraGraft. Second, based on the potassium hydrogenophosphate concentration and the lack of corresponding phosphate acid, there appears to be no buffering capacity for this solution. Given the high concentration of ascorbic acid, * Correspondence: [email protected] 1 Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany 2 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany Full list of author information is available at the end of the article
this solution will be highly acidic, even in the presence of sodium bicarbonate. Additionally, ascorbic acid used in the concentrations such as described by Fourquet was demonstrated to be highly cytotoxic [5]. Next, with the exception of glucose (which also had a different concentration from GALA and DuraGraft), it is impossible to calculate concentrations of the other components as these were all listed as milliliters added of solutions with no concentrations associated with them. Importantly, given the increase in ascorbic acid and the significant decreased buffering capacity, it must be assumed that the solution used in the present study had a very low acidic pH (i.e. close to pH 3 or lower). Therefore, this solution is extremely toxic to the endothelium of the implanted vei
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