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Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması

Year 2020, Volume: 10 Issue: 2, 145 - 149, 31.05.2020
https://doi.org/10.33631/duzcesbed.662453

Abstract

Amaç: Koroner arter
grefti olarak kullanılan safen venin hazırlanmasında farklı cerrahi toplama
teknikleri kullanılmaktadır. Bu çalışmanın amacı koroner arter baypas
greftlemesi (KABG) için kullanılan safen ven hazırlama işlemlerinden geleneksel
yöntem ile “no-touch” tekniği arasında apoptotik indeks açısından farklılığı
araştırmaktır.

Gereç ve
Yöntemler:

KABG uygulanan 40 hastada geleneksel ve “no-touch” cerrahi yöntemleri
kullanılarak toplanan safen venlerde apopitoz bakılarak prospektif, randomize
bir klinik çalışma yapıldı. Toplanan safen ven parçaları paraformaldehitte
bekletilerek tespit edildi. Kriyo cihazı ile 5 mikrometre kalınlığında kesitler
alındı. Örnekler modifiye TUNEL yöntemi ile işaretlenerek apopitotik hücre
ölümleri gösterildi. Doku kesitlerindeki TUNEL (+) ve (-) hücreler Stereo
Investigator version 7.5 görüntü işleme yazılımı kullanılarak tarafsız ve eşit
100 çerçeveye optik olarak bölünmüş alanlarda sayıldı. Apoptotik indeks; Hücre
/ Toplam Hücre oranı kullanılarak hesaplandı. Sonuçlar bağımsız gruplarda t
testi ile istatistiksel olarak değerlendirildi.

Bulgular: Geleneksel
yöntem ile “no-touch” tekniği apoptotik indeksleri karşılaştırıldı. Geleneksel
tekniğin uygulandığı grubunun apoptotik indeksi “no-touch” tekniği uygulanan
diğer gruba göre anlamlı oranda yüksek bulundu. Mekanik ve yapısal koruma venin
etrafını kuşatan yastıkçıklar tarafından sağlanmaktadır. Bu yastıkçıklarda
apoptotik hücre ölümünün daha az görülmesi safen vendeki doku hasarının daha az
olduğunu gösterir.







Sonuç: Safen ven grefti
hazırlamasında geleneksel yöntem yerine ‘no-touch’ cerrahi tekniğinin tercih
edilmesi ile doku hasarı ve vazospazm oluşumunun azalabileceği ve baypas
sonrası greftin açık kalma olasılığının artabileceği sonucuna ulaşıldı.

References

  • 1. Raja SG, Haider Z, Ahmad M, Zaman H. Saphenous vein grafts: to use or not to use? Heart Lung Circ. 2004; 13(4): 403-9.
  • 2. Fulton GJ, Davies MG, Hagen PO. Preservation of the endothelium in venous bypass grafts: relevance for graft patency. Asia-Pacific Heart J. 1997; 6(2): 98-106.
  • 3. Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in situ autogenous vein grafts. Ann. Surg. 1985; 202(1): 50-5.
  • 4. Angelini GD, Bryan AJ, Williams HM, Morgan R, Newby AC. Distention promotes platelet and leukocyte adhesion and reduces short-term patency in pig arteriovenous bypass grafts. J Thorac Cardiovasc Surg. 1999; 99(3): 433-9.
  • 5. Boerboom LE, Bonchek LI, Kissebah AH, Werner PH, Pepper JR, Olinger GN, et al. Effect of surgical trauma on tissue lipids in primate vein grafts: relation to plasma lipids. Circulation. 1980; 62(2 Pt 2): I142-7.
  • 6. Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001; 72(6): 2245-52.
  • 7. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Declercq SC, van Cauwelaert PA, et al. Foam cell replication and smooth muscle cell apoptosis in human saphenous vein grafts. Histopathology. 1994; 25(4): 365-71.
  • 8. Urbanek T, Skop B, Wiaderkiewicz R, Wilczok T, Ziaja K, Lebda-Wyborny T, et al. Smooth muscle cell apoptosis in primary varicose veins. Eur J Vasc Endovasc Surg. 2004; 28(6): 600-11.
  • 9. Lucassen PJ, Chung WCJ, Vermeulen JP, van Lookeren Campagne M, van Dierendonck aJH, Swaab DF. Microwave-enhanced in situ end-labeling of fragmented DNA:parametric studies in relation to postmortem delay and fixation of rat and human brain. J Histochem Cytochem. 1995; 43(11): 1163-71.
  • 10. Yildirim A, Ersoy Y, Ercan F, Atukeren P, Gumustas K, Uslu U, et al. Phosphodiesterase-5 inhibition by sildenafil citrate in a rat modelof bleomycin-induced lung fibrosis. Pulm Pharmacol Ther. 2010; 23(3): 215-21.
  • 11. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Van Cauwelaert PA. The modulation of smooth muscle cell phenotype is an early event in human aorta-coronary saphenous vein grafts. Virchows Arch A Pathol Anat Histopathol. 1992; 420(2): 155-62.
  • 12. Karayannacos PE, Rittgers E, Kakos GS, Williams TE Jr, Meckstroth CV, Vasko JS. Potential role of velocity and wall tension in vein graft failure. J Cardiovasc Surg. 1980; 21(2): 171-8.
  • 13. Rueda F, Souza D, Lima Rde C, Menezes A, Johansson B, Dashwood B, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol. 2008; 90(6): 356-62.
  • 14. Ramos JR, Berger K, Mansfield PB, Sauvage LR. Histologic fate and endothelial changes of distended and nondistended vein grafts. Ann Surg. 1976; 183(3): 205-28.
  • 15. He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993; 55(5):1210-7.
  • 16. Dündar S, Özcura F, Meteoğlu İ, Kara ME. Effects of long-term passive smoking on the vascular endothelial growth factor and apoptosis marker expression in the retina and choroid: an experimental study. Turk J Med Sci. 2012; 42(3): 377-83.
  • 17. Ashkenazi A, Dixit VM. Death receptors: signaling and modulation. Science. 1998; 281(5381): 1305-8.
  • 18. Polat A, Kayaselçuk F, Eğilmez R, Tuncer İ. Expression of Fas Antigen and Bcl-2 Protein in Liver Tissues of Patients with Chronic Hepatitis B. Turk J Med Sci. 2001; 31(6): 517-21.
  • 19. Goping IS, Gross A, Lavoie JN, Nguyen M, Jemmerson R, Roth K, et al. Regulated targeting of BAX to mitochondria. J Cell Biol. 1998; 143(1): 207-15.
  • 20. Griffiths GJ, Dubrez L, Morgan CP, Jones NA, Whitehouse J, Corfe BM, et al. Cell damage-induced conformational changes of the pro-apoptotic protein Bak in vivo precede the onset of apoptosis. J Cell Biol. 1999; 144(5): 903-14.
  • 21. Gottlieb RA, Gruol DL, Zhu JY, Engler RL. Preconditioning rabbit cardiomyocytes: role of pH, vacuolar proton ATPase and apoptosis. J Clin Invest. 1996; 97(10): 2391-8.
  • 22. Kiliçkan L, Gonca S, Dalçik C, Dalçik H, Solak M, Bayindir O, et al. General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2. J Cardiovasc Surg. 2006; 47(3): 315-22.
  • 23. Golledge J. Vein grafts: haemodynamic forces on the endotheliuma review. Eur J Vasc Endovasc Surg. 1997; 14(4): 333-43.
  • 24. Souza DS, Christofferson RH, Bomfim V, Filbey D. “No-touch” technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium. Scand Cardiovasc J. 1999; 33(6): 323-9.

Apoptotic Index of the Saphenous Vein Using Different Harvesting Methods for a Coronary Artery Bypass Graft

Year 2020, Volume: 10 Issue: 2, 145 - 149, 31.05.2020
https://doi.org/10.33631/duzcesbed.662453

Abstract

Aim: Different surgical harvesting
techniques are applied to prepare the saphenous vein which is used as a
coronary artery graft. The aim of this study is to investigate two different
surgical techniques, the conventional and no-touch, which are used in coronary
artery bypass grafting (CABG), in the preparation for saphenous vein by
comparing the apoptotic index results.



Material and Methods: A prospective, randomized
clinical study comparing 2 different saphenous vein harvesting techniques, the
conventional and no-touch methods, was performed with 40 patients who underwent
CABG. Small pieces of the SV tissues were fixed for paraformaldehyde. Up to 5 -
µm - thick cryosections were obtained with a cryostat. Samples have labeled
with modified TUNEL method and apoptotic cell deaths were shown. TUNEL (+) and
(-) cells were determined in tissue sections and counted in unbiased and equal
100 frames optically divided areas by using the Stereo Investigator version 7.5
image analysis software. The apoptotic index was calculated as the ratio of
apoptotic cells/total cells. Findings were statistically analyzed by using the
independent sample t test.



Results: The apoptotic index of the
conventional method and the no-touch surgical technique were compared. The
conventional technique apoptotic index results were significantly higher than
that no-touch technique group.
Mechanical
and structural protection is provided by the cushions surrounding the vein.
Less apoptotic cell death in these
cushions
means less tissue damage in the saphenous vein. The fact that the cushions
which provide venous, mechanical and structural support are more stable shows
that apoptotic cell death in the 'no-touch' technique group is less than the
other groups.

Conclusion: It was concluded that, in saphenous vein graft preparation,
preferring the “no-touch” surgical technique instead of conventional method
could decrease tissue injury and vasospasm and the possibility of the graft to
remain open after bypass could increase.

References

  • 1. Raja SG, Haider Z, Ahmad M, Zaman H. Saphenous vein grafts: to use or not to use? Heart Lung Circ. 2004; 13(4): 403-9.
  • 2. Fulton GJ, Davies MG, Hagen PO. Preservation of the endothelium in venous bypass grafts: relevance for graft patency. Asia-Pacific Heart J. 1997; 6(2): 98-106.
  • 3. Cambria RP, Megerman J, Abbott WM. Endothelial preservation in reversed and in situ autogenous vein grafts. Ann. Surg. 1985; 202(1): 50-5.
  • 4. Angelini GD, Bryan AJ, Williams HM, Morgan R, Newby AC. Distention promotes platelet and leukocyte adhesion and reduces short-term patency in pig arteriovenous bypass grafts. J Thorac Cardiovasc Surg. 1999; 99(3): 433-9.
  • 5. Boerboom LE, Bonchek LI, Kissebah AH, Werner PH, Pepper JR, Olinger GN, et al. Effect of surgical trauma on tissue lipids in primate vein grafts: relation to plasma lipids. Circulation. 1980; 62(2 Pt 2): I142-7.
  • 6. Thatte HS, Khuri SF. The coronary artery bypass conduit: I. Intraoperative endothelial injury and its implication on graft patency. Ann Thorac Surg. 2001; 72(6): 2245-52.
  • 7. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Declercq SC, van Cauwelaert PA, et al. Foam cell replication and smooth muscle cell apoptosis in human saphenous vein grafts. Histopathology. 1994; 25(4): 365-71.
  • 8. Urbanek T, Skop B, Wiaderkiewicz R, Wilczok T, Ziaja K, Lebda-Wyborny T, et al. Smooth muscle cell apoptosis in primary varicose veins. Eur J Vasc Endovasc Surg. 2004; 28(6): 600-11.
  • 9. Lucassen PJ, Chung WCJ, Vermeulen JP, van Lookeren Campagne M, van Dierendonck aJH, Swaab DF. Microwave-enhanced in situ end-labeling of fragmented DNA:parametric studies in relation to postmortem delay and fixation of rat and human brain. J Histochem Cytochem. 1995; 43(11): 1163-71.
  • 10. Yildirim A, Ersoy Y, Ercan F, Atukeren P, Gumustas K, Uslu U, et al. Phosphodiesterase-5 inhibition by sildenafil citrate in a rat modelof bleomycin-induced lung fibrosis. Pulm Pharmacol Ther. 2010; 23(3): 215-21.
  • 11. Kockx MM, Cambier BA, Bortier HE, De Meyer GR, Van Cauwelaert PA. The modulation of smooth muscle cell phenotype is an early event in human aorta-coronary saphenous vein grafts. Virchows Arch A Pathol Anat Histopathol. 1992; 420(2): 155-62.
  • 12. Karayannacos PE, Rittgers E, Kakos GS, Williams TE Jr, Meckstroth CV, Vasko JS. Potential role of velocity and wall tension in vein graft failure. J Cardiovasc Surg. 1980; 21(2): 171-8.
  • 13. Rueda F, Souza D, Lima Rde C, Menezes A, Johansson B, Dashwood B, et al. Novel no-touch technique of harvesting the saphenous vein for coronary artery bypass grafting. Arq Bras Cardiol. 2008; 90(6): 356-62.
  • 14. Ramos JR, Berger K, Mansfield PB, Sauvage LR. Histologic fate and endothelial changes of distended and nondistended vein grafts. Ann Surg. 1976; 183(3): 205-28.
  • 15. He GW, Rosenfeldt FL, Angus JA. Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting. Ann Thorac Surg. 1993; 55(5):1210-7.
  • 16. Dündar S, Özcura F, Meteoğlu İ, Kara ME. Effects of long-term passive smoking on the vascular endothelial growth factor and apoptosis marker expression in the retina and choroid: an experimental study. Turk J Med Sci. 2012; 42(3): 377-83.
  • 17. Ashkenazi A, Dixit VM. Death receptors: signaling and modulation. Science. 1998; 281(5381): 1305-8.
  • 18. Polat A, Kayaselçuk F, Eğilmez R, Tuncer İ. Expression of Fas Antigen and Bcl-2 Protein in Liver Tissues of Patients with Chronic Hepatitis B. Turk J Med Sci. 2001; 31(6): 517-21.
  • 19. Goping IS, Gross A, Lavoie JN, Nguyen M, Jemmerson R, Roth K, et al. Regulated targeting of BAX to mitochondria. J Cell Biol. 1998; 143(1): 207-15.
  • 20. Griffiths GJ, Dubrez L, Morgan CP, Jones NA, Whitehouse J, Corfe BM, et al. Cell damage-induced conformational changes of the pro-apoptotic protein Bak in vivo precede the onset of apoptosis. J Cell Biol. 1999; 144(5): 903-14.
  • 21. Gottlieb RA, Gruol DL, Zhu JY, Engler RL. Preconditioning rabbit cardiomyocytes: role of pH, vacuolar proton ATPase and apoptosis. J Clin Invest. 1996; 97(10): 2391-8.
  • 22. Kiliçkan L, Gonca S, Dalçik C, Dalçik H, Solak M, Bayindir O, et al. General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2. J Cardiovasc Surg. 2006; 47(3): 315-22.
  • 23. Golledge J. Vein grafts: haemodynamic forces on the endotheliuma review. Eur J Vasc Endovasc Surg. 1997; 14(4): 333-43.
  • 24. Souza DS, Christofferson RH, Bomfim V, Filbey D. “No-touch” technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium. Scand Cardiovasc J. 1999; 33(6): 323-9.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles
Authors

Ünal Uslu 0000-0003-3953-7131

Süheyla Gonca 0000-0002-6395-9978

Alev Cumbul 0000-0002-9491-8220

Onur Sen 0000-0001-6447-8327

Publication Date May 31, 2020
Submission Date December 21, 2019
Published in Issue Year 2020 Volume: 10 Issue: 2

Cite

APA Uslu, Ü., Gonca, S., Cumbul, A., Sen, O. (2020). Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 10(2), 145-149. https://doi.org/10.33631/duzcesbed.662453
AMA Uslu Ü, Gonca S, Cumbul A, Sen O. Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması. J DU Health Sci Inst. May 2020;10(2):145-149. doi:10.33631/duzcesbed.662453
Chicago Uslu, Ünal, Süheyla Gonca, Alev Cumbul, and Onur Sen. “Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10, no. 2 (May 2020): 145-49. https://doi.org/10.33631/duzcesbed.662453.
EndNote Uslu Ü, Gonca S, Cumbul A, Sen O (May 1, 2020) Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10 2 145–149.
IEEE Ü. Uslu, S. Gonca, A. Cumbul, and O. Sen, “Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması”, J DU Health Sci Inst, vol. 10, no. 2, pp. 145–149, 2020, doi: 10.33631/duzcesbed.662453.
ISNAD Uslu, Ünal et al. “Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi 10/2 (May 2020), 145-149. https://doi.org/10.33631/duzcesbed.662453.
JAMA Uslu Ü, Gonca S, Cumbul A, Sen O. Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması. J DU Health Sci Inst. 2020;10:145–149.
MLA Uslu, Ünal et al. “Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması”. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, vol. 10, no. 2, 2020, pp. 145-9, doi:10.33631/duzcesbed.662453.
Vancouver Uslu Ü, Gonca S, Cumbul A, Sen O. Koroner Arter Baypas Grefti İçin Farklı Yöntemler Kullanılarak Alınan Safen Veninin Apopitotik İndekslerinin Karşılaştırılması. J DU Health Sci Inst. 2020;10(2):145-9.