| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1998;66:1246-1249
© 1998 The Society of Thoracic Surgeons
a Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
b Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Accepted for publication April 24, 1998.
Address reprint requests to Dr Duhaylongsod, Duke University Medical Center, DUMC-3457, Durham, NC 27710
e-mail: (duhay001{at}mc.duke.edu)
Presented at the Seventieth Scientific Session of the American Heart Association, Orlando, FL, Nov 10–13, 1997.
Background. During less invasive coronary bypass operations on the beating heart, as well as conventional operations using continuous warm cardioplegia, a precise anastomosis is facilitated by a bloodless field. To maintain a clear field, many surgeons use high-flow gas insufflation. However, the potentially damaging effects of gas insufflation on coronary endothelium have not been elucidated.
Methods. Seven pigs underwent median sternotomy. Between two coronary occluders, an arteriotomy in the mid left anterior descending coronary artery (LAD) was performed. In the experimental group (n = 5), the operative field was kept clear by exposing the arteriotomy to a catheter-directed stream of carbon dioxide at 15 L/min. In the control group (n = 2), the arteriotomy was left open to room air. After 20 minutes, the segments of LAD exposed to carbon dioxide or room air, and the unexposed proximal LAD and right coronary artery, were processed, sectioned, and stained together. A murine anti-human tie-2 monoclonal antibody was used to identify endothelium.
Results. All unexposed LAD and right coronary artery segments and all LAD segments exposed only to room air demonstrated normal, contiguous staining of endothelium with the murine anti-human tie-2 monoclonal antibody. In contrast, all LAD segments exposed to high-flow carbon dioxide gas insufflation demonstrated near-complete loss of endothelium.
Conclusions. These data demonstrate that high-flow carbon dioxide gas insufflation denudes the coronary artery of its endothelium. This exposes blood elements to the subendothelium and promotes clotting, and endothelial loss may promote smooth muscle cell migration and proliferation. These events set the stage for early and late graft failure.
This article has been cited by other articles:
|
|
 |
|
  K. M. Brown, M. M. Sabetai, and G. E. Venn Gas embolization from the left ventricle and aortic root: A possible side effect of high-flow gas insufflation during coronary artery surgery Ann. Thorac. Surg., July 1, 2004; 78(1): 387 - 388. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Capdeville and J. H. Lee Off-Pump Coronary Artery Bypass Surgery: Revival of an Old Technique Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 345 - 361. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Okazaki, K. Takarabe, J.-i. Murayama, E. Suenaga, K. Furukawa, K. Rikitake, M. Natsuaki, and T. Itoh Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 834 - 839. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. G. Duhaylongsod Minimally Invasive Cardiac Surgery Defined Arch Surg, March 1, 2000; 135(3): 296 - 301. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Posacioglu, Y. Atay, T. Yagdi, T. Calkavur, M. Cikirikcioglu, S. Buket, A. Hamulu, M. Yuksel, and O. Bilkay Simple and Cost-Effective Gas Jet for Non-Pump Coronary Bypass Surgery Asian Cardiovasc Thorac Ann, September 1, 1999; 7(3): 250 - 251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. P. Perrault, P. Menasche, and P. M. Vanhoutte High-flow gas insufflation to facilitate MIDCAB Ann. Thorac. Surg., March 1, 1999; 67(3): 893 - 893. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
