Ann Thorac Surg 2002;73:1865
© 2002 The Society of Thoracic Surgeons
Original article: cardiovascular
Invited commentary
Guo-Wei He, MD, PhDa,b
a Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Block B, 5A, Shatin, New Territories, Hong Kong, People’s Republic of China
b Clinical Professor of Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR USA
e-mail: gwhe{at}cuhk.edu.hk
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Introduction
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Arterial grafts in coronary artery bypass grafting (CABG) are being increasingly used due to superior long-term patency. The left internal thoracic artery (ITA) and the radial artery (RA) are the two major grafts. Endothelial function of the grafts is vitally important in preventing vasospasm, particularly in the early postoperative period and in maintaining long-term patency [1, 2]. Endothelial cells produce a number of vasodilating substances that are inhibitors of platelet aggregation. Endothelium-dependent relaxation is an index of endothelial function.
This article studied the effect of "statins" on the endothelial function of grafts. The conclusion that cerivastatin significantly preserves endothelium-dependent vasodilatation may have clinical implications. There are a few points that should be considered by the reader. First, incubation with cerivastatin during surgery can only be for a short time, such as half an hour or so. As this study indicated, the effect of cerivastatin is not significant even at 2 hours of incubation. Second, the possibility that preoperative intake of the drug may preserve endothelial function is not addressed. Third, the concentration of cerivastatin used for incubation (1 µM/L) is much higher than the plasma concentration (2.27 to 2.88 µg/L; see "Comment" in the article). The statement in "Comment" that the concentration of cerivastatin used in the present study is 1 µg/L may be a writing error. Whether early postoperative administration of cerivastatin at a dose that produces a much lower plasma concentration than that used in this study is effective is questionable and needs further study. Lastly, the drug preserves endothelial function in RA and has a similar trend in ITA, although not significant (see Fig 1C). We have recently demonstrated that basal and stimulated release of nitric oxide and endothelium-derived hyperpolarizing factor-mediated hyperpolarization in the ITA are significantly greater than that in the RA. However, whether cerivastatin only preserves RA endothelium, and why if true, needs further investigation.
In brief, this study provides useful information for improvement of graft function in CABG from a new aspect, but there is still a gap between the laboratory study and future clinical application.(3)
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References
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He G.-W. Arterial grafts for coronary artery bypass: biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 1999;67:277-284.[Abstract/Free Full Text]
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He G.-W. Arterial grafts for coronary surgery: vasospasm and patency rate. J Thorac Cardiovasc Surg 2001;121:431-433.[Free Full Text]
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He G.-W., Liu Z.-G. Comparison of nitric oxide release and endothelium-derived hyperpolarizing factor-mediated hyperpolarization between human radial and internal mammary arteries. Circulation 2001;104(Suppl I):I344-I349.
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Effects of cerivastatin on vascular function of human radial and left internal thoracic arteries
- Koki Nakamura, Sharif Al-Ruzzeh, Adrian H. Chester, Ilona Schmidt, Mahmoud Barbir, Magdi H. Yacoub, and Mohamed Amrani
Ann. Thorac. Surg. 2002 73: 1860-1865.
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Introduction
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