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Ann Thorac Surg 2004;78:543-548
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Chronic ultrastructural effects of temporary intraluminal shunts in a porcine off-pump model

Jens Wippermann, MDa*, Johannes M. Albes, MDb, Raimund Bruhin, MDa, Martin Hartrumpf, MDb, Rüdiger Vollandt, MDd, Hartwig Kosmehl, MDc, Thorsten Wahlers, MDa

a Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Jena, Germany
d Department of Medical Statistics, Informatics and Documentation, University Hospital Jena, Jena, Germany
b Heart-Center Brandenburg, Bernau, Germany
c Institute of Pathology, Helios Hospital, Erfurt, Germany

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Wippermann, Department of Cardiothoracic and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07747 Jena-Lobeda, Germany
e-mail: jens.wippermann{at}med.uni-jena.de

BACKGROUND: Temporary intraluminal shunts (TILS) are routinely used in off-pump revascularization to facilitate the anastomosis while maintaining myocardial blood supply. Whereas tourniquet-occlusion can cause vessel wall trauma, potentially adverse chronic effects of TILS on the coronary intima have not been evaluated yet. This chronic large animal study investigated ultrastructural effects of TILS on the vessel wall.

METHODS: Four groups of acute and chronic pigs with either tourniquet-occlusion (TOUR) or TILS (40 kg; acute, n = 12; chronic, n = 20) were analyzed. Animals underwent median sternotomy, heparin (150 U/kg) administration, and left anterior descending coronary artery exposure. In groups with TOUR the left anterior descending coronary artery was temporarily occluded (10 minutes) with a tourniquet. In groups with TILS a silicone shunt (1.5 mm diameter, 12 mm length) was placed in the left anterior descending coronary artery more than 10 minutes and then removed, and the insertion was repaired. Thirty minutes after reperfusion all acute animals were sacrificed whereas chronic animals were extubated, maintained for 3 months, and then sacrificed. The left anterior descending coronary artery regions of occlusion or placement of the TILS silicone bulbs were examined histopathologically by scanning and transmission electron microscopy by a blinded pathologist.

RESULTS: In both acute and chronic investigations animals in the TILS group exhibited significantly less morphologic damage than animals in the TOUR group. In the acute phase significantly more loss of cell junction (p = 0.037), loss of endothelium (p = 0.032), and intimal edema (p = 0.037) in the TOUR group than in the TILS group was observed. Three months later, characteristic features with a changed pattern were detected: vacuolization of the cell (p = 0.03), loss of cell junction (p = 0.042), and removal of basal membrane (p = 0.046) as well as extensive loss of endothelium (p = 0.003) in the TOUR group compared with the TILS group.

CONCLUSIONS: Intimal lesions occur with both maneuvers early and late. However, animals in the TOUR group exhibited injuries significantly more often and more severely. Therefore, acute and chronic intimal integrity of the coronary vessel may be better preserved using TILS and may thus have a positive impact on the extent of de novo stenosis and long-term prognosis of the revascularized region.




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