Skeletonization of internal thoracic artery affects its innervation and reactivity

Objective: The studies showing the superior characteristics of ITA graft and its impact on the clinical results of coronary artery surgery were performed with ITA harvested almost exclusively as a pedicle. This study assesses the impact of ITA skeletonization on its innervation and reactivity. Metho...

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Published in:European journal of cardio-thoracic surgery 2005-10, Vol.28 (4), p.551-557
Main Authors: Deja, Marek Andrzej, Gołba, Krzysztof S., Malinowski, Marcin, Woś, Stanisław, Kolowca, Maciej, Biernat, Jolanta, Kajor, Maciej, Spyt, Tomasz J.
Format: Article
Language:English
Subjects:
Acetylcholine - pharmacology
Biological and medical sciences
Cardiology. Vascular system
Coronary Artery Bypass - methods
Coronary Artery Disease - physiopathology
Coronary Artery Disease - surgery
Dose-Response Relationship, Drug
Endothelium, Vascular - drug effects
Endothelium, Vascular - physiopathology
Endothelium-dependent relaxation
Endothelium-independent relaxation
Humans
Immunohistochemistry - methods
Internal thoracic artery
Mammary Arteries - drug effects
Mammary Arteries - pathology
Mammary Arteries - physiopathology
Mammary Arteries - transplantation
Medical sciences
Nerve Fibers
Nitroprusside - pharmacology
Norepinephrine - pharmacology
Pneumology
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Sympathectomy
Tissue and Organ Harvesting - adverse effects
Tissue and Organ Harvesting - methods
Vasoconstrictor Agents - pharmacology
Vasodilator Agents - pharmacology
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Summary:Objective: The studies showing the superior characteristics of ITA graft and its impact on the clinical results of coronary artery surgery were performed with ITA harvested almost exclusively as a pedicle. This study assesses the impact of ITA skeletonization on its innervation and reactivity. Methods: Segments of skeletonized and non-skeletonized ITA were stained with antibodies against protein S-100 to look for the presence of sympathetic nerve fibers. The functional studies were performed on segments of discarded human pedicled ITA that were divided into two 3mm rings, one skeletonized and another non-skeletonized. We compared concentration–effect relationships for the contraction to norepinephrine and endothelium-dependent relaxation to acetylcholine and bradykinin, as well as endothelium-independent relaxation to sodium nitroprusside in skeletonized and non-skeletonized segments of the same ITA. Results: Skeletonized ITA was devoid of protein S-100 positive nerve fibers. It contracted stronger (maximal response 37.0±2.04 vs. 25.4±1.83mN (P≪0.001)) and was twice as sensitive to norepinephrine: pD2 6.03±0.10 vs. 5.70±0.12 (P=0.035). The endothelium-dependent relaxation responses did not differ between skeletonized and non-skeletonized ITA rings. The skeletonized ITA rings appeared over 10 times more sensitive to sodium nitroprusside: pD2 6.66±0.20 vs. 5.59±0.37 (P=0.012)—potency ratio 11.61. The maximal responses did not differ significantly: 112.0±6.71 vs. 129.4±16.4% (P=0.33). Conclusions: Skeletonization results in sympathectomy of ITA. It has no effect on endothelium-dependent relaxation but increases reactivity of ITA to norepinephrine. This augmented response to ±-agonist is small, in comparison with over a ten-fold increase in sensitivity to sodium nitroprusside. Pedicled and skeletonized ITA are functionally significantly different vessels when studied in vitro.
ISSN:1010-7940
1873-734X
DOI:10.1016/j.ejcts.2005.06.037