Protecting the Endothelial Integrity of Internal Thoracic Arteries[1]

Abstract

Background: Previous functional studies on human internal thoracic arteries, comparing the effect of the traditional harvesting method (occlusion with a clip) with a method leaving the artery perfused, revealed considerably impaired endothelial function associated with enhanced contractility after clipping. We have now investigated whether these observations could be correlated (1) with plasma markers of endothelial dysfunction, and (2) with structural changes in the endothelial layer. Methods: 32 patients were randomly distributed into groups of clipped and perfused arteries. Arterial blood samples were obtained from both the artery and extracorporeal circulation to determine sP-selectin, sE-selectin, sL-selectin, and thrombomodulin using enzyme-linked immunosorbent assay. Arteries from three patients were examined by scanning electron microscopy. Results: Concentrations of sP-selectin and thrombomodulin were significantly higher in plasma from clipped arteries compared to perfused arteries, whereas sE-selectin and sL-selectin concentrations were similar within the groups. Scanning electron microscopy revealed significant structural changes and loss of endothelial cells in clipped arteries. Conclusion: Biochemical and structural results support our findings that leaving the internal thoracic artery perfused preserves endothelial function in the arterial graft.

Key words

Internal thoracic arteries - coronary artery bypass surgery - endothelium - harvesting

1 Presented at the Annual Meeting of the German Society of Thoracic and Cardiovascular Surgery, Hamburg 2005.

References

• 1 Grondin C M, Campeau L, Lesperance J, Enjalbert M, Bourassa M G. Comparison of late changes in internal mammary artery and saphenous vein grafts in two consecutive series of patients 10 years after operation.  Circulation. 1984;  70 1208-1212
• 2 Loop F D, Lytle B W, Cosgrove D M. et al . Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.  N Engl J Med. 1986;  314 1-6
• 3 Grapow M TR, Preiss M, Bernet F, Zerkowski H R. Surgical treatment in end-stage coronary artery disease.  Kardiovask Med. 2002;  5 190-197
• 4 Mills N L, Bringaze 3rd W L. Preparation of the internal mammary artery graft. Which is the best method?.  J Thorac Cardiovasc Surg. 1989;  98 73-77
• 5 Sarabu M R, McClung J A, Fass A, Reed G E. Early postoperative spasm in left internal mammary artery bypass grafts.  Ann Thorac Surg. 1987;  44 199-200
• 6 Shelton M E, Forman M B, Virmani R, Bajaj A, Stoney W S, Atkinson J B. A comparison of morphologic and angiographic findings in long-term internal mammary artery and saphenous vein bypass grafts.  J Am Coll Cardiol. 1988;  11 297-307
• 7 Grapow M T, Kern T, Reineke D C. et al . Improved endothelial function after a modified harvesting technique of the internal thoracic artery.  Eur J Cardiothorac Surg. 2003;  23 956-960
• 8 Moncada S, Higgs A. The L-arginine-nitric oxide pathway.  N Engl J Med. 1993;  329 2002-2012
• 9 Luscher T F, Noll G. The pathogenesis of cardiovascular disease: role of the endothelium as a target and mediator.  Atherosclerosis. 1995;  118 S81-90
• 10 Frenette P S, Johnson R C, Hynes R O, Wagner D D. Platelets roll on stimulated endothelium in vivo: an interaction mediated by endothelial P-selectin.  Proc Natl Acad Sci USA. 1995;  92 7450-7454
• 11 Frenette P S, Wagner D D. Insights into selectin function from knockout mice.  Thromb Haemost. 1997;  78 60-64
• 12 Ridker P M, Buring J E, Rifai N. Soluble P-selectin and the risk of future cardiovascular events.  Circ. 2001;  103 491-495
• 13 Ruchaud-Sparagano M H, Drost E M, Donnelly S C, Bird M I, Haslett C, Dransfield I. Potential pro-inflammatory effects of soluble E-selectin upon neutrophil function.  Eur J Immunol. 1998;  28 80-89
• 14 Bevilacqua M P, Nelson R M. Endothelial-leukocyte adhesion molecules in inflammation and metastasis.  Thromb Haemost. 1993;  70 152-154
• 15 Wyble C W, Hynes K L, Kuchibhotla J, Marcus B C, Hallahan D, Gewertz B L. TNF-alpha and IL-1 upregulate membrane-bound and soluble E-selectin through a common pathway.  J Surg Res. 1997;  73 107-112
• 16 Kozuka K, Kohriyama T, Nomura E, Ikeda J, Kajikawa H, Nakamura S. Endothelial markers and adhesion molecules in acute ischemic stroke - sequential change and differences in stroke subtype.  Atherosclerosis. 2002;  161 161-168
• 17 Chong A Y, Blann A D, Lip G Y. Assessment of endothelial damage and dysfunction: observations in relation to heart failure.  Qjm. 2003;  96 253-267
• 18 Boehme M W, Deng Y, Raeth U. et al . Release of thrombomodulin from endothelial cells by concerted action of TNF-alpha and neutrophils: in vivo and in vitro studies.  Immunology. 1996;  87 134-140
• 19 Esmon C T, Owen W G. Identification of an endothelial cell cofactor for thrombin-catalyzed activation of protein C.  Proc Natl Acad Sci USA. 1981;  78 2249-2252
• 20 Esmon N L, Owen W G, Esmon C T. Isolation of a membrane-bound cofactor for thrombin-catalyzed activation of protein C.  J Biol Chem. 1982;  257 859-864

1 Presented at the Annual Meeting of the German Society of Thoracic and Cardiovascular Surgery, Hamburg 2005.