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@#In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.
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Objective To evaluate the efficacy and clinical significance of medical chemical glue as an external stent in improving the fluency rate of venous bypass graft after coronary artery bypass grafting .Methods Randomly selected 200 pa-tients from April 2010 to December 2016 included who were underwent coronary artery bypass grafting in Beijing Anzhen Hospi-tal.All patients had different degrees of angina , and coronary angiography showed multi-branches artery lesion.They were ran-domly divided into two groups, 100 in each group.Spray gel group: coronary artery bypass grafting simultaneously spraying medical chemical glue on the surface of the bridge vessel.Unsprayed gel group:simple coronary artery bypass grafting.All 200 patients were followed up in June 2018.The follow-up content mainly included: recent recurrence of angina pectoris, recent echocardiography and electrocardiogram report, coronary CTA or coronary angiography results, and current living conditions. The data obtained were collectively summarized and compared .Results The follow-up rate was 96％ in the sprayed group, and 92％ in the unsprayed group.Compared with the unsprayed group , the incidence of chest pain and angina pectoris was significantly lower in the sprayed group(23.96％ vs.40.22％, P<0.05), the venous occlusion rate of the vein bypass graft in the sprayed group was significantly lower(29.17％ vs.55.43％, P<0.01), the probability of death due to cardiac causes in the sprayed group was significant decrease(1.04％ vs.6.52％, P<0.05), the number of patients with the main adverse cardiac and cerebral events(MACCE) in the sprayed group was significantly lower(9.38％ vs.21.74％, P<0.01), all with statistically significant differences .The number of patients with heart failure and recurrent myocardial infarction was lower in the sprayed group, but there were no statistically significant differences .Conclusion Medical chemical glue as an external stent does play a role in improving the venous patency rate after coronary artery bypass grafting , and it is reliable for the preven-tion and treatment of vein bypass vascular stenosis after coronary artery bypass grafting .
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Objective: To study the long-term inhibitory effect of external stent on atherosclerosis of autologous vein graft in hypercholesterolemic rabbit and the possible mechanism. Methods: Hypercholesterolemic model was established in 15 rabbits and their bilateral jugular veins were anastomosed with bilateral carotid arteries. One jugular vein graft was stented with a polytetrafluoroethylene tube (external stent group) and the other receiving no stenting served as control (unstent group). Ultrasound was used to evaluate the haemodynamics 12 weeks after operation. The grafts were harvested to examine the thickness and area of intima and media, the deposition of lipid in the vessel wall, and the distribution of VCAM-1 positive cells. Scanning electron microscope (SEM) was used to evaluate the regeneration of endothelium. Results: Ultrasound results showed that the stent group was laminar blood flow and the control group had vortex flow. The thickness and areas of intima and media were significantly lower in the stent group than in the control group (P<0.01); the foam cells and deposition of lipid in the vein wall were significantly less in the stent group (P<0.01). No atherosclerosis plaque was founded in the stenk group. VCAM-1 positive cells in the control group were significantly more than those in the stent group (P<0.01). SEM showed that the endothelia were orderly, closely, and evenly arranged in the stent group; while those in the control group were in disorder, with larger gaps and different sizes. Conclusion: External stent can improve hemodynamics of vein graft, accelerate endothelium remodeling and reduce the deposition of lipid; it can also inhibit vein graft smooth muscle hyperplasia, and reduce foam cells in vein graft, indicating that external stent can inhibit the atherosclerosis of vein grafts in a long run.
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Objective To investigate the effect of non-restrictive external stent on both cell proliferation of rabbit vein grafts and prevention from hyperplasia of the grafts' neointima. Methods 36 New Zealand white rabbits were randomly divided into two groups, each animal was subjected to a reversed autologous venous graft between external jugular vein and common carotid artery. In stenting group (group S), the vein grafts were surrounded by a 6 mm in diameter non-restrictive stent, and in non-stenting group (group NS), there is no stent to support the vein grafts. The grafts were harvested 1 week (1W), 2 weeks (2W) and 4 weeks (4W) after surgery, respectively. The sections were stained with hematoxylin and eosin stain, ?-smooth muscle actin (?-SMA) and proliferating cell nuclear antigen (PCNA) immunocytochemistry stain. PCNA index was calculated in intima, media and adventitia, respectively. Results (1) HE staining: From 1W to 4W, the hyperplasia of intima and media appeared gradually in both group S and group NS, nevertheless such hyperplasia in group S was lessintense than in group NS. (2) ?-SMA staining: Almost all cells in media were positive, but few cells were positive in intima of both groups at 1W; the thickness of intima of both groups increased gradually, and almost all cells except endothelial cells were positive in intima in both groups, though the thickness of intima of group S was smaller than in group NS at 2W and 4W. (3) PCNA index: the index of intima in both two groups peaked at 2W, and the index of intima in group S was less than in group NS at 2W and 4W, P
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Objective:To study the long-term inhibitory effect of external stent on atherosclerosis of autologous vein graft in hypercholesterolemic rabbit and the possible mechanism.Methods:Hypercholesterolemic model was established in 15 rabbits and their bilateral jugular veins were anastomosed with bilateral carotid arteries.One jugular vein graft was stented with a polytetrafluoroethylene tube(external stent group)and the other receiving no stenting served as control(unstent group).Ultrasound was used to evaluate the haemodynamics 12 weeks after operation.The grafts were harvested to examine the thickness and area of intima and media,the deposition of lipid in the vessel wall,and the distribution of VCAM-1 positive cells.Scanning electron microscope(SEM)was used to evaluate the regeneration of endothelium.Results:Ultrasound results showed that the stent group was laminar blood flow and the control group had vortex flow.The thickness and areas of intima and media were significantly lower in the stent group than in the control group(P