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J Thorac Cardiovasc Surg 1997;114:38-45
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

WOUND HEALING AROUND AND WITHIN SAPHENOUS VEIN BYPASS GRAFTS

Supported in part by the National Institutes of Health (grant HL-44150).

Received for publication May 13, 1996 revisions requested August 9, 1996; revisions received Oct. 1, 1996 accepted for publication Jan. 30, 1997. Address for reprints: John D. Mannion, Suite 607 College, Jefferson Medical College, 1025 Walnut St., Philadelphia, PA 19107.

Abstract

Background: Myofibroblasts are a prominent cell type in wound healing. The goal of this study was to examine the extent to which myofibroblasts contribute to structural changes in saphenous vein bypass grafts. Methods and results: Control veins and reversed saphenous vein bypass conduits of porcine carotid arteries were examined 2 to 4, 7 to 14, and 30 to 90 days after surgery with immunohistochemical markers of cellular proliferation (proliferating cell nuclear antigen), cytoskeletal protein production (–smooth muscle actin and desmin), and histochemistry (Verhoeff's stain). Control veins demonstrated an extremely low level of cellular proliferation and no evidence of myofibroblasts in the adventitia, media, or intima. After bypass grafting, cellular proliferation was followed by myofibroblast formation, which occurred in the perivascular area and within the media. This was evidenced by a dense, but transient, expression of –smooth muscle actin and a variable expression of desmin at 1 to 2 weeks, and with a significant increase in collagenous tissue by 1 to 3 months. Major cytoskeletal protein changes also occurred in the intima, with the appearence of –smooth muscle actin positive cells at 7 to 14 days. –Smooth muscle actin was still present in the neointima at 1 to 3 months, which is compatible with a persistent myofibroblast formation. Conclusion: Myofibroblast formation occurs around and within saphenous veins after bypass grafting. This phenomenon is associated with significant remodeling of the vein grafts. The histologic changes are strikingly similar to events that occur during wound healing and may have implications for the development of neointimal hyperplasia and late vein graft disease

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