Key result
Controlled hydraulic dilatation preserved venous structural integrity and functional viability comparable to intact veins, avoiding endothelial damage seen with uncontrolled dilatation.
Why the study?
Manual high-pressure hydraulic dilatation negatively affects venous conduits and contributes to shunt incompetence, prompting the need for standardized pressure-controlled dilatation.
Does controlled hydraulic dilatation of venous conduits improve structural integrity and functional viability compared to uncontrolled dilatation in CABG?
Does controlled hydraulic dilatation of venous conduits improve structural integrity and functional viability compared to uncontrolled dilatation in CABG?
Controlled hydraulic dilatation of venous conduits minimizes morphofunctional alterations compared to conventional uncontrolled dilatation, potentially improving autovenous shunt function in CABG.
Answers are grounded in this paper and cite their sources.
Caution against high-pressure manual injection in vein grafts; leaves open optimal pressure limits for prospective validation.
Hydraulic dilatation is used in everyday cardiac surgical practice for assessment of leak-proofness and prevention of spasm of autovenous shunts. The classical technique envisages manual high-pressure solution injection, which exerts a negative effect on venous conduits and is one of the causes of incompetence of shunts in the postoperative period. Limiting pressure during hydraulic dilatation is necessary to minimize morphological changes and preserve functional viability of venous conduits. The purpose of the present study was to develop and assess efficacy of a standardized methodology of controlled hydraulic dilatation of venous conduits. We worked out an original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation. This was followed by assessing morphological changes and functional viability of venous segments after controlled hydraulic dilatation as compared with veins after conventional uncontrolled hydraulic dilatation and the control intact veins. Uncontrolled hydraulic dilatation was accompanied by endothelial damage (p<0.05), multiple conduit wall tears (p<0.05) according to the findings of light microscopy, leading to a significant decrease in the functional vitality of the venous conduit (a decreased reaction to hyperpotassium solution, phenylephrine, acetylcholine and sodium nitroprusside (p<0.05) according to the findings of biophysical examination. Our original technique of controlled hydraulic dilatation of venous conduits under perfusion pressure of artificial circulation made it possible not only to evaluate leak-proofness of the vessel but also to achieve comparable to the control segments parameters of structural integrity of the venous wall and functional viability of the conduit. Thus, using the developed method of controlled hydraulic dilatation makes it possible to minimize morphofunctional alterations in venous conduits, influencing the function of autovenous shunts.
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Вечерский et al. (2021) studied Coronary artery bypass grafting. Controlled hydraulic dilatation vs. Conventional uncontrolled hydraulic dilatation and intact veins was evaluated on Morphological changes and functional viability (p=<0.05). Controlled hydraulic dilatation preserved venous structural integrity and functional viability comparable to intact veins, avoiding endothelial damage seen with uncontrolled dilatation.
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