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Theses

Les greffons vasculaires en chirurgie coronaire

Abstract : Internal thoracic arteries (ITAs) and venous grafts are commonly used in coronary artery bypass grafting. 1) Intimal hyperplasia (IH) constitutes an adaptative mechanism observed when saphenous vein graft is exposed to arterial blood pressure. Storage solutions aiming on decreasing this IH have been identified in previous in vitro studies. 2) Cardio pulmonary bypass can be performed using either a centrifugal pump, with a non -pulsatile flow or a roller pump, producing a pulsatile flow. Non pulsatile flow was showed to induce a systemic inflammatory response therefor damaging the myogenic tone of resistance arteries in a rat model. The aims of this study were : 1) To compare the impact of storage solutions on saphenous vein grafts implanted in aortic position in a rat model. 2) To evaluate the impact of the flow generated by pumps on endothelial functionality of ITAs and the systemic inflammatory response. 1) IH and graft thrombosis occurred in more than 50% of cases when venous graft was stored in heparinized saline solution, autologous heparinized blood or GALA anti-oxydant solution, and implanted in arterial position. A parietal inflammatory response was observed in venous graft as well as distal abdominal aorta. 2) Vascular reactivity was conserved whatever the pump used. Systemic inflammatory response was observed while the intraparietal inflammatory was not modified in the graft. To conclude, 1) the use of GALA anti-oxydant solution did not decrease the risk of intimal hyperplasia when venous graft is exposed to arterial blood flow 2) exposure of internal thoracic artery to centrifugal and roller pumps did not affect endothelial functionality nor vascular reactivity.
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Submitted on : Tuesday, December 1, 2020 - 5:16:07 PM
Last modification on : Thursday, December 10, 2020 - 10:25:47 AM

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  • HAL Id : tel-03034432, version 1

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Olivier Fouquet. Les greffons vasculaires en chirurgie coronaire. Médecine humaine et pathologie. Université d'Angers, 2019. Français. ⟨NNT : 2019ANGE0039⟩. ⟨tel-03034432⟩

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