Recent clinical data suggest intraoperative preservation of human saphenous vein (HSV) in normal saline is associated with vein graft failure. We evaluated the influence of several preservation media on acute physiologic function and cellular viability of HSV conduit.
Unprepared (UP) HSV obtained from coronary artery bypass graft patients was characterized on a muscle bath after 2-hour storage in 6 solutions: Plasma-Lyte A, 0.9% NaCl (normal saline), University of Wisconsin solution, Celsior solution, autologous whole blood, or glutathione-ascorbic acid L-arginine (GALA) solution. Vascular smooth muscle contractility was assessed after exposure to depolarizing KCl and phenylephrine. The relaxation of phenylephrine-precontracted HSV to sodium nitroprusside and carbachol (endothelial-independent and -dependent relaxation, respectively) was also assessed. Cellular viability was determined via the methyl thiazolyl tetrazolium (MTT) assay. Rat aortae were used to assess the effect of pH during graft preservation on endothelial-dependent relaxation.
Preservation of HSV in normal saline and autologous whole blood impaired contractile responses to KCl relative to UP tissues, whereas preservation in University of Wisconsin solution and Celsior solution enhanced contractile responses (P < .05). Relative to UP tissues, responses to phenylephrine were decreased with preservation in normal saline, whereas preservation in University of Wisconsin solution, Celsior solution, and GALA all potentiated these responses (P < .05). Only preservation in normal saline impaired endothelial-independent relaxation (P = .005). Preservation in Plasma-Lyte A (P = .02), normal saline (P = .002), and University of Wisconsin solution (P = .02) impaired endothelial-dependent relaxation. Normal saline preservation decreased MTT viability index relative to UP tissues (0.02 ± 0.002 mg−10.5 mL−1 vs 0.033 ± 0.005 mg−10.5 mL−1; P = .03). Endothelial function was impaired by acidic pH in rat aorta.
Preservation of HSV in normal saline causes graft injury leading to impaired physiologic function and decreased viability of the HSV. This harm is mitigated by the use of buffered salt solutions as preservation media.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Evaluation of endoscopic vein extraction on structural and functional viability of saphenous vein endothelium.J Cardiothorac Surg. 2011; 6: 82
- Effects on arterial intima of saline infusions.J Surg Res. 1974; 16: 197-203
- Functional and morphological evaluation of canine veins following preservation in different storage media.J Surg Res. 1997; 68: 106-115
- Edifoligide and long-term outcomes after coronary artery bypass grafting: PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) 5-year results.Am Heart J. 2012; 164: 379-386 e1
- Vein graft preservation solutions, patency, and outcomes after coronary artery bypass graft surgery: follow-up from the PREVENT IV randomized clinical trial.JAMA Surg. 2014; 149: 798-805
- Surgical vein graft preparation promotes cellular dysfunction, oxidative stress, and intimal hyperplasia in human saphenous vein.J Vasc Surg. 2014; 60: 202-211
- Brilliant blue FCF as an alternative dye for saphenous vein graft marking: effect on conduit function.JAMA Surg. 2014; 149: 1176-1181
- Multi-photon microscopic evaluation of saphenous vein endothelium and its preservation with a new solution, GALA.Ann Thorac Surg. 2003; 75: 1145-1152
- Organ preservation.Annu Rev Med. 1995; 46: 235-247
- Experimental evaluation of Celsior, a new heart preservation solution.Eur J Cardiothorac Surg. 1994; 8: 207-213
- Intimal thickness associated with endothelial dysfunction in human vein grafts.J Surg Res. 2013; 180: e55-e62
- Detrimental effects of mechanical stretch on smooth muscle function in saphenous veins.J Vasc Surg. 2011; 53: 454-460
- Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxicity assays.J Immunol Methods. 1983; 65: 55-63
- Characterization of the cellular reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT): subcellular localization, substrate dependence, and involvement of mitochondrial electron transport in MTT reduction.Arch Biochem Biophys. 1993; 303: 474-482
- Improving early graft function: role of preservation.Transplant Proc. 1997; 29: 3510-3511
- Preservation solutions for transplantation.Transplant Proc. 1999; 31: 2069-2070
- University of Wisconsin solution and human saphenous vein graft preservation: preliminary anatomic report.Eur J Cardiothorac Surg. 1993; 7: 548-552
- Storage of saphenous vein grafts prior to coronary artery bypass grafting: is autologous whole blood more effective than saline in preserving graft function?.Interact Cardiovasc Thorac Surg. 2012; 15: 720-725
- Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts.Eur J Cardiothorac Surg. 2011; 40: 811-815
- Normothermic versus hypothermic ex vivo flush using a novel phosphate-free preservation solution (AQIX) in porcine kidneys.J Surg Res. 2011; 171: 275-282
- Balanced versus unbalanced salt solutions: what difference does it make?.Best Pract Res Clin Anaesthesiol. 2014; 28: 235-247
- Intimal proliferation in an organ culture of human saphenous vein.Am J Pathol. 1990; 137: 1401-1410
- Advances and new frontiers in the pathophysiology of venous neointimal hyperplasia and dialysis access stenosis.Adv Chronic Kidney Dis. 2009; 16: 329-338
- Surgical preparation induces injury and promotes smooth muscle cell proliferation in a culture of human saphenous vein.Cardiovasc Res. 1993; 27: 1961-1967
- Oxidative stress and vein graft failure: a focus on NADH oxidase, nitric oxide and eicosanoids.Curr Opin Pharmacol. 2012; 12: 160-165
- Systemic administration of an antagonist of the ATP-sensitive receptor P2X7 improves recovery after spinal cord injury.Proc Natl Acad Sci U S A. 2009; 106: 12489-12493
- Brilliant blue FCF is a nontoxic dye for saphenous vein graft marking that abrogates response to injury.J Vasc Surg. 2015; (In Press)
- Pressure control during preparation of saphenous veins.JAMA Surg. 2014; 149: 655-662
Published online: May 20, 2015
Accepted: March 18, 2015
Disclosures: Authors have no disclosures.
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.