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Impact of distension pressure on saphenous vein endothelial injury in coronary artery bypass grafting

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Introduction

Long saphenous vein grafts (LSVGs) are pivotal conduits in coronary artery bypass grafting (CABG), yet concerns persist regarding early failure and long-term patency. Endothelial damage, a potent initiator of graft failure, necessitates exploration of factors contributing to endothelial injury during LSVG preparation.

Methods

A prospective, single-center study was conducted, assessing the impact of unregulated distension pressure on LSVG endothelium during CABG. Histological and CD31 (cluster of differentiation 31) immunohistochemical analyses were performed on 21 paired vein samples, categorized into non-distended (group A) and distended (group B) groups. Pressure recordings were obtained using different syringe sizes during vein distension.

Results

Histological examination revealed a significantly higher percentage of endothelial cell loss in distended veins (31.95% ± 31.31) compared to non-distended veins (11.67% ± 28.65) (p = 0.034). CD31 immunohistochemistry corroborated greater endothelial cell loss in distended veins (p = 0.001). The pressure recordings with a 20-cc syringe, as opposed to using a 10-cc syringe, were considerably lower (44.5 mmHg vs. 92.75 mmHg) emphasizing the inverse relationship between syringe size and pressure generated. In our study, pre-existing endothelial injury was observed in one-third of diabetic patients (36%), with all instances of such injury exclusively identified in individuals with diabetes.

Conclusion

Unregulated distension pressure during LSVG preparation is associated with greater endothelial damage, as evidenced by histological and immunohistochemical analyses. The inverse relationship between syringe size and pressure underscores the importance of controlled distension.

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Data availability

All data supporting the findings of this study will be made available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. NH Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099, India

    Patralekha Das, Azhar Sayyed, Sundar Bharath, Sufina Shales, Mrinalendu Das, Sanjib Pattari & Pradeep Narayan

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  1. Patralekha Das
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  2. Azhar Sayyed
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  3. Sundar Bharath
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  4. Sufina Shales
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  6. Sanjib Pattari
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  7. Pradeep Narayan
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Contributions

PD: contributed towards the conception of the study, sample collection, data acquisition, writing and revising the manuscript and approval of the final version.

AS: contributed towards data acquisition, revising the manuscript, and approval of the final version.

SB: contributed towards sample collection, data acquisition, and approval of the final version.

SS: contributed towards the data acquisition, revising the manuscript, and approval of the final version.

SP: conducted the histological and CD31 immunohistochemical analyses, validation and approval of the final version.

MD: contributed towards revising the manuscript and approval of the final version.

PN: contributed towards the conception of the study, data analysis, writing and revising the manuscript, and approval of the final version.

Corresponding author

Correspondence to Pradeep Narayan.

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Ethics committee approval was obtained (Reference no: AP/2022/062).

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Informed consent was obtained from all participants.

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We declare that all procedures followed in our research involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments.

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Das, P., Sayyed, A., Bharath, S. et al. Impact of distension pressure on saphenous vein endothelial injury in coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg (2024). https://doi.org/10.1007/s12055-024-01731-8

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