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J Thorac Cardiovasc Surg 1994;108:382-383
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Effects of storage with University of Wisconsin solution on human saphenous vein endothelium

Department of Thoracic and Cardiovascular Surgery
Hospital "L. Sacco"
Milan, Italy

To the Editor:

In cardiac surgery the importance of preserving the endothelial lining, especially during coronary artery bypass graft procedures, is widely known. ^{1, 2}

In a recent report Drs. Mankad, Slavik, and Yacoub ³ presented a new and interesting investigation concerning the effects of University of Wisconsin solution (UWS) at different temperatures on endothelial function. The authors showed that hypothermic UWS best preserves the functional integrity of the endothelium.

Such a solution has also been used by others, ⁴ at room temperature and in comparisons with other solutions, for storage of the baboon saphenous vein. On the basis of responses to contractile or relaxant agents and of reports on histologic changes, the authors demonstrated that UWS and physiologic salt solution (PSS) are the best options for storage of saphenous vein.

We recently investigated the effect of UWS and other bathing media on morphologic features of the human saphenous vein endothelium by means of an electron microscopic comparative analysis. Furthermore, we evaluated contractile activity of human saphenous vein specimens at different bathing durations. All patients in the study had given their informed written consent.

Distal segments of human saphenous vein were harvested for microscopic evaluation by a "no-touch" technique from eight patients who had undergone bypass grafting. Each segment was divided into seven specimens after a low-pressure distention (120 mm Hg) with PSS at room temperature. The first of the segments was fixed with 2.5% glutaraldehyde solution, immediately after being harvested, for basal evaluation; three were fixed after 30 minutes, and three after being bathed for 5 hours at 4° C in autologous, oxygenated, heparinized blood (AOHB); heparinized PSS with added papaverine (0.4 gm/ml) (HPSS); or UWS. To evaluate contractile activity of the human saphenous vein, we used 3 cm long segments harvested with the same technique from 12 other patients. Each venous segment, once cleaned of the adherent connective tissue, was then cut into three ring-shaped specimens that were preserved with the same solutions for 30 minutes, 5 hours, and 24 hours. We repeated this procedure four times with each solution. After each bathing period was ended the specimens were superfused in a tissue organ bath at a rate of 2.5 ml/min with Krebs solution at 37° C. The solution was gassed with 95% oxygen and 5% carbon dioxide. A contractile response was then provoked with a 30 mmol/L dose of potassium chloride and was recorded with auxotonic transducers at a resting tension of 2 gm after a 30-minute period of equilibration.

At microscopic evaluation the control specimens had the best preserved endothelium that one could expect. AOHB appeared to be the least adequate solution for preservation: endothelial cell loss and detachment were already evident after a 30-minutes bathing period. Specimens stored in HSSP and UWS had a well-preserved and comparable structure after 30 minutes' bathing even if a major degree of alteration was evident with HSSP (presence of intracellular edema). After 5 hours' of bathing all specimens stored in AOHB and HSSP showed complete endothelial necrosis, whereas specimens stored in UWS were better preserved (only subendothelial edema and abnormal mitochondria).

Contractile response was present at any bathing time in AOHB and UWS specimens; on the contrary, specimens preserved with HSSP were viable only after 30 minutes (100% of cases) and after 5 hours (50% of cases) of bathing.

In conclusion, our data suggest that UWS, considered effective in maintaining endothelial function in the isolated rat heart as well as in isolated baboon saphenous vein, can also be considered a suitable storage solution for human saphenous vein. Even though UWS was as effective as AOHB in provoking contractile response of the human saphenous vein, this study really shows that UWS better preserves endothelial structure after a prolonged storage. Nevertheless, we think that further studies are necessary, because of the multitude of factors that can affect endothelium (i.e., harvesting techniques, ischemia timing, pressure distention, irrigation solutions, and storage temperature), to confirm the superiority of UWS in preventing endothelial damage and to identify it as the ideal bathing medium for human saphenous vein stor age.

References

1. Catinella FP, Cunningham JN, Srungaram RK, et al. The factors influencing early patency of coronary artery bypass vein grafts. J THORAC CARDIOVASC SURG 1982;83:686-700.[Abstract]
   
2. Zilla P, von Oppel U, Deutsch M. The endothelium: a key to the future. J Cardiac Surg 1993;8:32-60.[Medline]
   
3. Mankad P, Slavik Z, Yacoub M. Endothelial dysfunction caused by University of Wisconsin preservation solution in the rat heart. J THORAC CARDIOVASC SURG 1992;104:1618-24.[Abstract]
   
4. Boerboom LE, Wooldridge TA, Olinger GN, Rusch NJ. Effects of storage solutions on contraction and relaxation of isolated saphenous veins. J Cardiovasc Pharmacol 1992;20(Suppl 12):S80-4.
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Santoli, E. Articles by Sala, E. Search for Related Content PubMed PubMed Citation Articles by Santoli, E. Articles by Sala, E.