Preserving the endothelium in saphenous vein graft with both conventional and no-touch preparation
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(2020) 15:317
RESEARCH ARTICLE
Open Access
Preserving the endothelium in saphenous vein graft with both conventional and notouch preparation Toshiro Saito, Hiroshi Kurazumi, Ryo Suzuki, Yutaro Matsuno, Akihito Mikamo and Kimikazu Hamano*
Abstract Background: Despite the inferior patency compared to arterial grafts, a saphenous vein graft (SVG) is widely used for coronary artery bypass grafting (CABG). A lower atherosclerosis rate and higher patency have been reported for SVG obtained via the no-touch technique (NT) than via conventional preparation (CV). Although CV-mediated endothelial dysfunction is implied, the precise mechanism underlying the higher patency with NT is poorly understood. Methods: Human residual SVGs during CABG and SVG sections after autopsy were analyzed. The endothelial surface was observed using scanning electron microscopy (SEM) and blindly compared between CV and NT. The endothelial integrity was also analyzed with immunohistochemistry. Results: Unexpectedly, the hyperfine structure on SEM was comparable between CV and NT before grafting, and microvillus, a characteristic of endothelium, was indistinguishable between them. Von Willebrand Factor, an endothelial marker, was equally detected throughout the vascular wall in both groups from residual and postmortem sections. Conclusions: The morphological integrity of the endothelium was successfully preserved in SVG with CV, even at an ultrastructural level. Although its functionality remains to be addressed, other factors than the endothelium may be involved in the high patency obtained by NT. The present findings suggest that the characteristics of NT and surgical methodology should be reconsidered. Keywords: Coronary artery bypass grafting (CABG), Saphenous vein grafts (SVGs), Conventional preparation (CV), Notouch technique (NT), Endothelium
Background Coronary artery bypass grafting (CABG) is a standard therapy for ischemic heart disease. Despite the inferior patency compared to arterial grafts, saphenous vein grafts (SVGs) are still widely transplanted for CABG due to their ease of manipulation [1–4]. Consequently, the long-term patency of SVG has been thoroughly investigated. Conventional preparation (CV) of SVG, consisting of deprivation of surrounding tissues and distension, has * Correspondence: [email protected] Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi 755-8505, Japan
been utilized for decades but is implied to be associated with atherogenesis and a poor patency rate [5–8]. Since the 1990s, the no-touch technique (NT), which preserves the outer tissues without distension, has been recognized as the superior alternative to CV due to its salutary effect. Accumulating evidence indicates that SVGs harvested with NT exhibit lower rates of atherosclerosis and higher patency than those harvested via CV [9–12]. Many cardiac surgeons have an intense interest in the higher patency of NT-SVG and its mechanism. However, the detailed mech
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