Tv. Bilfinger et al., CRYOPRESERVED VEINS IN MYOCARDIAL REVASCULARIZATION - POSSIBLE MECHANISM FOR THEIR INCREASED FAILURE, The Annals of thoracic surgery, 63(4), 1997, pp. 1063-1069
Background. Cryopreserved veins are used as conduits for myocardial re
vascularization. However, a high failure rate associated with their us
e has been reported anecdotally. Methods. To find an explanation for t
he poor performance of cryopreserved vein grafts, we conducted a retro
spective 5-year study on all patients at a single institution in whom
cryopreserved vein grafts were used. We further performed in vitro stu
dies measuring cell adhesion, nitric oxide production, and contractile
capacity of saphenous vein, internal thoracic artery, and cryopreserv
ed veins. Results. Forty-one patients were identified in whom one or m
ore cryopreserved veins were used as a last resort. Sixteen had events
(death or recatheterization). Seven deaths occurred (17%). Event-free
survival was 50% at 12 months. Activated granulocyte/monocyte endothe
lial adherence could be lowered in internal thoracic arteries and saph
enous veins with morphine incubation (50% and 57%, respectively), but
not in cryopreserved veins. Simultaneous increases in nitric oxide rel
ease were also found in internal thoracic arteries and saphenous veins
, but not cryopreserved veins. In addition, cryopreserved veins showed
a diminished contractile capacity under experimental conditions. Conc
lusions. In this highly select group of patients, cryopreserved veins
had a high early failure rate, which may be partially due to the inabi
lity of the endothelium to participate in immunovascular processes. (C
) 1997 by The Society of Thoracic Surgeons.