Safen Ven Greft Aterosklerozunun Önlenmesinde Glutaraldehit"in Rolü: Deneysel Modelde Koroner Bypass Çalışması ile Değerlendirme

Objective: Most of the saphenous vein grafts occlude after aortocoronary bypass surgery due to the neointimal hyperplasia. There are some studies suggest that the aldehydes have anti-mitotic effects preventing intimal hyperplasia. The purpose of this study is to search whether tanning of the saphenous grafts with glutaraldehyde solution before their implantation can prevent both neointimal hyperplasia and smooth muscle proliferation. Material and Methods: The effects of glutaraldehyde on saphenous vein graft disease was evaluated in an experimental study on dogs. Coronary artery bypass grafting operations were performed in each subject by using beating heart technique. The subjects were categorized into two different groups. In the first group saphenous veins were treated with only ringer lactate solution (Control group, n=5). In the second group saphenous veins were fixed with %1.8 glutaraldehyde solution (Glutaraldehyde group n=5). After thirty days we extracted the implanted vein grafts and evaluated histopathologically with hematoxylin-eosin (HE), Masson"s tricrom (MT) type 1 collogen, elastic van Gieson (EVG), alfa smooth muscle actin (ASMA) and factor 8 immunhistochemical stains. Results: In the glutaraldehyde group one subject died in first 24 hour and the other one died 14th day of the operation. In the glutaraldehyde group neointimal hyperplasia was not observed; nevertheless in the control group advanced neointimal hyperplasia was seen in all slices. When compared the increase in both collogen and elastic fibers in the groups to each other, there was significant difference between the groups. In the grafts of the glutaraldehyde group, thrombus incorporated to the graft wall was not observed however it was encountered in the three subjects of the control group. Inflammatory response which was thought to be due to chemical irritation of the glutaraldehyde developed in glutaraldehyde group. Conclusion: It was showed that glutaraldehyde suppressed the neointimal hyperplasia and smooth muscle cell proliferation which are processors of the atherosclerosis of the arterialised saphenous vein grafts. We believe that the side effects of glutaraldehyde like dissections or inflammatory responses can be surmounted by means of optimal dose titrations of the drug. This study will set the baseline for further studies.