Outside stenting of the vein graft decreases VEGF-A expression and induces significant down-regulation of VEGFR-1 in the intimal and medial layers after the re-endothelialization period.

BACKGROUND: Neointimal hyperplasia (NIH) in vein grafts implanted into the arterial system develops after re-endothelialization and is considered a significant risk factor of occlusion. Evidence suggests that VEGF-A expression with VEGFR-2 activation and/or VEGFR-1 down-regulation might be involved in inhibiting NIH formation. The aim was to assess whether a stented vein graft (SV) has an impact on VEGF-A and VEGFR-1 expression compared with non-stented vein grafts. MATERIAL/METHODS: Twelve sheep received a radial vein with an outside stent (SV) and a radial vein (RV) transplanted into their carotid arteries. The covering of the luminal surface of the SV and RV grafts by endothelium was 98.3% and 96.3%, respectively, at 6 weeks. From the 6th to 12th weeks after transplantation, the time course of total VEGF-A expression and VEGFR-1 expression were evaluated separately for the intima and media. RESULTS: VEGF-A and VEGFR-1 expression were significantly lower in the SV than in the RV group in the intima. In the media the SV grafts were associated with higher VEGF-A and VEGFR-1 expression at 6 and 8 weeks, but lower values were observed at weeks 10 and 12 compared with the RV grafts. Comparing the time courses of VEGF-A and VEGFR-1 expression in the intima and media with intimal/medial thickening in the SV and RV groups, negative correlations for the SV grafts were found. CONCLUSIONS: These findings indicate that outside stenting of the vein graft decreases VEGF-A expression and induces significant down-regulation of VEGFR-1 in the intima and media after the re-endothelialization.

Quality of life in young, professionally active men undergoing on-pump coronary artery bypass grafting--short-term follow-up results.

BACKGROUND: The impact of coronary artery bypass grafting (CABG) on the quality of life (QoL) is one of the important measures of the efficacy of the procedure. This issue in young, professionally active male patients has not been extensively studied. AIM: To assess QoL before and after on-pump CABG, and before and after cardiac rehabilitation in young men with low operative risk. METHODS: The study group comprised 50 men aged 54.4 +/- 5.6 years who were professionally active before the surgery. The QoL was assessed on the basis of the MacNew questionnaire (in points). We analysed QoL changes and effects of basic demographic and peri-operative data on QoL during a short-term follow-up. RESULTS: All components of QoL deteriorated shortly after CABG: emotional - from 4.97 +/- 0.96 to 4.66 +/- 1.0 (p = 0.03); physical - from 4.49 +/- 1.1 to 4.2 +/- 1.2 (p = 0.02); and social - from 4.68 +/- 1.0 to 4.47 +/- 1.1 (p = 0.1). Pre-operative physical and social QoL positively correlated with age (r = 0.45 and r = 0.37, respectively) and left ventricular ejection fraction (LVEF) (r = 0.49 and r = 0.48, respectively). However, there was a negative impact of history of myocardial infarction on physical QoL (p < 0.05). A negative influence of cardiopulmonary bypass time (r = -0.45) and cross-aortic clamp time (r = -0.36) on physical QoL was also noted. The QoL values were also influenced by class of angina symptoms (R = -0.33 / -0.42), total drainage (r = -0.11 / -0.34) and quantity of grafts (R = -0.35 / -0.42). During rehabilitation, QoL significantly improved: emotional - from 5.29 +/- 0.92 to 5.96 +/- 0.9 (p = 0.01); physical - from 4.66 +/- 1.1 to 5.42 +/- 1.2 (p < 0.01); and social - from 4.69 +/- 1.2 to 5.65 +/- 1.1 (p < 0.01). The QoL during rehabilitation was correlated with baseline peri-operative risk (for logistic EuroSCORE algorithm r = -0.21 / -0.31 and for EuroSCORE R = -0.47 / -0.89). Significant determinants of some components of QoL were also LVEF (r= 0.26 / 0.47), morphological blood parameters (r = 0.37 / 0.43), baseline CCS class (R = 0.31 / 0.58), age (r = -0.41 / -0.83), and extent of surgery defined by cardiopulmonary bypass time, cross-aortic clamp duration and total drainage. CONCLUSIONS: Quality of life in young, professionally active men significantly deteriorates a few days after on-pump CABG but systematically improves during the next weeks, particularly after rehabilitation. Pre-operative QoL correlates positively with age and LVEF, and negatively with a history of myocardial infarction. Age, pre-operative risk, angina symptoms and the extent of surgery have negative effects on physical QoL after CABG during short-term observation.

A new external stent - intimal proliferation and apoptosis in the vein graft in the animal model.

BACKGROUND: We have previously showed that the extravascular dacron mesh stent wrapped around a vein graft and implanted into the arterial system prevented the hypertrophy of the graft's wall, impeded the overgrowth of the intima and decreased the proliferation rate of venous graft cellular elements. AIM: To determine the role of cellular proliferation and apoptosis in the process of remodelling in the stent in an animal model in a 12-week period. METHODS: Male sheep (n = 21) received by transplantation the hybrid graft (group 1) or carotid artery radial vein grafts (group 2). A hybrid graft was composed of a radial vein, collagen fibrin glue and highly flexible torlen/dacron mesh tubing. Grafts were retrieved on day 5, 9 and then week 4, 6, 8, 10, 12, respectively. A proliferation process was assessed using a Ki-67 antigen kit. The presence of apoptosis was detected using a TUNEL kit, strictly according to the manufacturer's manual. RESULTS: The number of proliferating cells has presented a decreasing trend in both groups, whereas the mean quantity of apoptotic cells increased over a 12-week period (p < 0.001) in both groups. Proliferation was more prominent during the first 5 weeks in both groups. The trend had a tendency to reverse during the last 7 weeks of observation. The ratio of proliferating to apoptotic cells differed between groups (1.6 vs. 1.9 on day 5 and 0.2 vs. 0.6 in week 12, in group 1 and group 2, respectively). No linear correlation between proliferation and apoptosis was observed (p > 0.05). CONCLUSIONS: Different kinetics in the trico hybrid graft group in comparison with the radial vein graft group was observed, with a more prominent cellular turnover in the trico hybrid graft. Apoptosis in an unprotected vein wall was overcomed by the proliferation process. In trico hybrid vein grafts, beneficial remodelling of the intimal layer was predominantly dependent on inhibition of intimal proliferation rather than the effect of changes of the apoptosis ratio. There was no linear correlation between proliferation and apoptosis in the investigated grafts.

Primary malignant fibrous histiocytoma of the heart.

A 72-year-old male diagnosed with heart failure and dyspnea was found to have a lesion in his right atrium. Histological examination of the tumor revealed it to be a malignant fibrous histiocytoma. The patient's management and subsequent follow-up are presented.

[Antegrade warm blood cardioplegia versus cold blood cardioplegia in normothermia in the coronary artery bypass grafting procedures. Troponine I release as a marker of periopertive myocardial ischemia]. / Porównanie stopnia niedokrwienia miesnia sercowego w operacjach pomostowania tetnic wiencowych w normotermii przy uzyciu roztworu cieplej krwistej i zimnej krwistej kardiopleginy. Troponina I jako okolooperacyjny marker niedokrwienia miesnia sercowego.

UNLABELLED: Warm myocardial protection has had a strong impact on modern cardiac surgery. The O2 consumption of a heart, arrested by potassium-enriched normothermic blood is 90% less than baseline values. Hypothermia gives only a slight reduction in oxygene consumption. THE AIM OF THIS STUDY: was to test the quality of myocardial protection provided by intermittent antegrade warm blood cardioplegia (IAWBC) by comparing it with cold blood cardioplegia. MATERIAL AND METHODS: We designed a prospective randomized study by using 2 different temperatures of blood cardioplegia: warm, from 35 degrees C to 37 degrees C (group I--36 men and 14 women, mean age 56 +/- 7); and cold, from 6 degrees C to 8 degrees C (group II--40 men and 10 women, mean age 58 +/- 9). Cardiac troponin I release was the criterion used to evaluate the adequacy of myocardial protection, RESULTS: The heartbeat in 92% of patients treated with warm cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic crossclamp compared with only 18% of the cold cardioplegia group. Cardiac troponin I concentration was significantly higher in the cold group. Our study demonstrates a significant reduction of myocardial cell damage with the use of IAWBC. CONCLUSION: Our clinical results have shown that IAWBC is a superior method compared to intermittent cold cardioplegia.

Force distribution in wire sternum sutures: the consequences for sternal closure rigidity.

BACKGROUND: This article provides a biomechanical analysis of the distribution of force in wire sutures used for sternal closure in cardiothoracic surgery. MATERIAL/METHODS: The parameters we measured included displacement in the elastic region, plastic limit, and rupture load on the closure. Force distribution analysis was carried out for every kind of wire suture. A linear regression line of displacement as a function of increasing load was determined for each closure method. RESULTS: Straight wire had less displacement at each load, figure-8 had medium, and interlocking multitwisted (IM) had the most displacement within the elastic range of the specimen. The differences between straight and interlocking multitwisted sutures were statistically significant. When the plastic limit was compared between straight and interlocking multitwisted closure, the differences were statistically significant. In the straight suture the forces used to approximate the sternal halves are perpendicular to the incision. With the figure-8 and interlocking multitwisted suture, the forces are dispersed and the effective approximation force is lower than that applied to the wires. CONCLUSIONS: Straight wires provide good fixation stability for the durability of the sternum, and the somewhat lower strength could be compensated by increasing the number of sutures. The figure-8 and IM have better strength and are less likely to cut the sternum because of advantageous redistribution of shearing forces of the wire as compared to straight closures.

A new outside stent--does it prevent vein graft intimal proliferation?

OBJECTIVE: The saphenous vein subjected to arterial pressure stretches to its elastic limits and constitutes intimal hyperplasia. Sheathing of the vein graft with pressure-resistant tubing might prolong vein graft patency. METHODS: Twenty-one sheep received radial vein grafts or hybrid grafts composed of radial vein, collagen fibrin glue and highly flexible torlen/dacron mesh tubing transplanted into the carotid artery position. Veins were examined with the use of light and electron microscopy. Proliferating cell antigen (Ki-67) stains served as markers of proliferation. RESULTS: The mean wall thickness of both intimal and medial layers was evaluated. The mean intimal wall thickness was 19+/-11 microm in hybrid grafts vs. 24+/-7 microm in unsheathed grafts (P<0.001); 22+/-6 vs. 26+/-10 microm (P<0.001); 23+/-8 vs. 52+/-15 microm (P<0.001); 37+/-21 vs. 90+/-31 microm (P<0.001); 57+/-31 vs. 104+/-28 microm (P<0.001); 58+/-21 vs. 133+/-32 microm (P<0.001); and 72+/-22 vs. 244+/-100 microm (P<0.001) after respectively 5 days, 9 days, 4 weeks, 6 weeks, 8 weeks, 10 weeks and 12 weeks from implantation. Electronic microscope examination of hybrid grafts revealed a smooth endothelial layer with intact nuclei and an intima composed of layers of collagen and muscle fibers. In unsheathed grafts endothelial edema and nuclear destruction were observed. CONCLUSIONS: The external vein graft support with mesh tubing reduces intimal and medial layer thickening and cell proliferation in composite vein grafts transplanted in the arterial position.