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Ann Thorac Surg 2001;71:122-127
© 2001 The Society of Thoracic Surgeons
a Department of Cardiac Surgery, Leopold-Franzens-University, Innsbruck, Austria
b Institute of Anatomy and Histology, Leopold-Franzens-University, Innsbruck, Austria
c Städtische Kliniken, Oldenburg, Germany
Accepted for publication July 11, 2000.
Address reprint requests to Dr Hangler, Department of Cardiac Surgery, Leopold-Franzens-University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
e-mail: herbert.hangler{at}uibk.ac.at
Background. Occlusion of coronary arteries during beating heart surgery bears the potential for mechanical trauma to the arterial wall with consequent endothelial injury. The aim of this study was to elucidate the effects of local occlusion on the beating heart in human coronary arteries.
Methods. Coronary arteries of patients with dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 10) undergoing heart transplantation were locally occluded after starting cardiopulmonary bypass. Immediately after excision of the diseased heart, the vessels were fixed. Unoccluded segments served as controls. Integrity of endothelial lining was observed with scanning electron microscopy.
Results. Scanning electron microscopy revealed significantly more severe endothelial injury in the area of occlusion than in the adjacent, not manipulated control segments. In the region of local occlusion, plaque rupture was noted in three of 34 atherosclerotic vessel specimens, injury to side branches was evident in two of 44, and local microthrombus formation was evident in six of 44 samples.
Conclusions. Local occlusion of human coronary arteries during beating heart coronary surgery may cause focal endothelial denudation, local microthrombosis, atherosclerotic plaque rupture, and injury to target vessel side branches.
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