High-flow gas insufflation to facilitate MIDCABG: Effects on coronary endothelium

William R. Burfeind, Francis G. Duhaylongsod, Brian H. Annex, David Samuelson

Research output: Contribution to journalArticle

Abstract

Background. During less invasive coronary bypass operations on the beating heart, as well as conventional operations using continuous warm cardioplegia, a precise anastomosis is facilitated by a bloodless field. To maintain a clear field, many surgeons use high-flow gas insufflation. However, the potentially damaging effects of gas insufflation on coronary endothelium have not been elucidated. Methods. Seven pigs underwent median sternotomy. Between two coronary occluders, an arteriotomy in the mid left anterior descending coronary artery (LAD) was performed. In the experimental group (n = 5), the operative field was kept clear by exposing the arteriotomy to a catheter-directed stream of carbon dioxide at 15 L/min. In the control group (n = 2), the arteriotomy was left open to room air. After 20 minutes, the segments of LAD exposed to carbon dioxide or room air, and the unexposed proximal LAD and right coronary artery, were processed, sectioned, and stained together. A murine anti-human tie-2 monoclonal antibody was used to identify endothelium. Results. All unexposed LAD and right coronary artery segments and all LAD segments exposed only to room air demonstrated normal, contiguous staining of endothelium with the murine anti-human tie-2 monoclonal antibody. In contrast, all LAD segments exposed to high-flow carbon dioxide gas insufflation demonstrated near-complete loss of endothelium. Conclusions. These data demonstrate that high-flow carbon dioxide gas insufflation denudes the coronary artery of its endothelium. This exposes blood elements to the subendothelium and promotes clotting, and endothelial loss may promote smooth muscle cell migration and proliferation. These events set the stage for early and late graft failure.

Original languageEnglish (US)
Pages (from-to)1246-1249
Number of pages4
JournalAnnals of Thoracic Surgery
Volume66
Issue number4
DOIs
StatePublished - Oct 1 1998
Externally publishedYes

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Insufflation
Endothelium
Carbon Dioxide
Gases
Coronary Vessels
Air
Monoclonal Antibodies
Induced Heart Arrest
Sternotomy
Smooth Muscle Myocytes
Cell Movement
Swine
Catheters
Cell Proliferation
Staining and Labeling
Transplants
Control Groups

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

High-flow gas insufflation to facilitate MIDCABG : Effects on coronary endothelium. / Burfeind, William R.; Duhaylongsod, Francis G.; Annex, Brian H.; Samuelson, David.

In: Annals of Thoracic Surgery, Vol. 66, No. 4, 01.10.1998, p. 1246-1249.

Research output: Contribution to journalArticle

Burfeind, William R. ; Duhaylongsod, Francis G. ; Annex, Brian H. ; Samuelson, David. / High-flow gas insufflation to facilitate MIDCABG : Effects on coronary endothelium. In: Annals of Thoracic Surgery. 1998 ; Vol. 66, No. 4. pp. 1246-1249.
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