Does perivascular fibrin glue application have a preventive effect for the endothelial damage on saphenous vein graft? An experimental model

Abstract

Background. The effect of tissue adhesives on coronary grafts in cardiac surgery is a controversial issue. Objective. The aim of this study is to investigate the effect of fibrin glue (FG) applied around the saphenous vein grafts (SVG) in preventing cellular damage resulting from intraluminal pressure increase. Methods. Twenty volunteer patients were included in this ex vivo study. The SVGs remained after coronary artery bypass grafting were connected to the arterial line of the cardiopulmonary bypass circuit. The grafts were divided into two segments and one segment received perivascular FG applied whereas the other part was used plain. SVGs were kept in circulation at 120 mmHg pressure 250 mL/min flow rate for 60 min. The tissues were sent for histopathological examination to determine the endothelial damage. Results. Endothelial damage was more pronounced in the control group when compared with the FG group. In the FG group, no damage was seen in 13 samples and no Type 3 endothelial damage was observe whereas Type 1 injury was detected in seven specimens, Type 2 injury was observed in seven specimens, and Type 3 injury was detected in two specimens in the control group. Conclusion. Perivascular application of FG on the SVG showed a protective effect against endothelial damage resulting from increased intraluminal pressure.

Antecedentes. El efecto de los adhesivos tisulares sobre los injertos coronarios en cirugía cardíaca es un tema controvertido. Objetivo. Investigar el efecto del pegamento de fibrina aplicado alrededor de los injertos de vena safena para prevenir el daño celular resultante del aumento de la presión intraluminal. Método. En este estudio ex vivo fueron incluidos 20 pacientes voluntarios. Los injertos de vena safena que quedaron después del injerto de derivación de la arteria coronaria se conectaron a la línea arterial del circuito de derivación cardiopulmonar. Los injertos se dividieron en dos segmentos y a uno de ellos se le aplicó pegamento de fibrina perivascular, mientras que la otra parte se usó sola. Los injertos de vena safena se mantuvieron en circulación a una presión de 120 mmHg y una velocidad de flujo de 250 ml/min durante 60 minutos. Los tejidos se enviaron para examen histopatológico para determinar el daño endotelial. Resultados. El daño endotelial fue más pronunciado en el grupo de control ue en el grupo de pegamento de fibrina. Se observó lesión de tipo 2 en siete muestras del grupo de pegamento de fibrina y lesión de tipo 3 en dos muestras del grupo de control. Conclusiones. La aplicación perivascular de pegamento de fibrina en los injertos de vena safena mostró un efecto protector contra el daño endotelial resultante del aumento de la presión intraluminal.