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Eur J Cardiothorac Surg 2008;33:1162-1163. doi:10.1016/j.ejcts.2008.03.020
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Reply to Dashwood et al.

Marek Andrzej Deja*, Marcin Malinowski

2nd Department of Cardiac Surgery, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland

Received 18 March 2008; accepted 19 March 2008.

* Corresponding author. Tel.: +48 32 2526093; fax: +48 32 2526093. (Email: mdeja{at}slam.katowice.pl).

Key Words: Internal thoracic artery • ADRF • CABG • Perivascular tissue • Nitric oxide • Saphenous vein

We thank Dashwood et al. for their interest and comments regarding our manuscript [1]. We used to be enthusiastic regarding ITA skeletonization but with growing awareness of the active role of perivascular tissue we are becoming less and less so [2]. Our study showed that the factor responsible for anticontractile properties of perivascular tissue (PVT) in human internal thoracic artery (ITA) acts independent of NO and PGI2 [3]. It suggests that PVT releases agents, different to these well known relaxing factors that clearly affect vascular reactivity, adventitia/adipocyte derived relaxing factor (ADRF).

We appreciate Dashwood et al.'s findings on the importance of perivascular tissue of saphenous vein [4,5]. Their papers clearly show that preserving perivascular fat results in improved long term patency rates of SV grafts. Dashwood et al. proved that PVT of SV possesses strong NOS activity and argue it might contribute to the improved patency of SV harvested as a pedicle. Still, we do not know if this high NOS activity is found in PVT, nor whether SV PVT releases ADRF. Likewise, it remains to be shown if ADRF, similarly to NO, has the ability to affect patency rates of the vessels.

Meanwhile, we have analyzed the influence of internal thoracic artery's PVT on the function of other vessels such as radial artery and saphenous veins and we failed to find any anticontractile effect. This may suggest that ADRF may be a vessel specific agent. (These data will be presented during the 57th ESCVS International Congress in Barcelona). It is crucial now to establish the nature and precise mechanisms of action of ADRF and check if this is truly a vessel specific factor which may affect clinical outcome of non-skeletonized grafts.

References

  1. Dashwood MR, Souza DSR, Fernandez-Alfonso MS. RE: Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent anticontractile factor. Eur J Cardiothorac Surg 2008;33:1161-1162.[Free Full Text]
  2. Deja MA, Golba KS, Malinowski M, Wos S, Biernat J, Kajor M, Spyt T. Skeletonization of internal thoracic artery affects its innervation and reactivity. Eur J Cardiothorac Surg 2005;28:551-557.[Abstract/Free Full Text]
  3. Malinowski M, Deja MA, Golba KS, Rolender T, Biernat J, Wos W. Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent anticontractile factor. Eur J Cardiothorac Surg 2008;33:225-231.[Abstract/Free Full Text]
  4. Dashwood MR, Dooley A, Shi-Wen X, Abraham DJ, Souza DSR. Does perivascular fat-derived nitric oxide play a role in improved saphenous vein graft patency in patients undergoing coronary artery bypass surgery?. J Vasc Res 2007;44:175-181.[CrossRef][Medline]
  5. Souza DSR, Johansson B, Bojö L, Karlsson R, Geijer H, Filbey L, Bodin L, Arbeus M, Dashwood MR. Harvesting the saphenous vein with surrounding tissue for CABG provides long-term patency comparable to the left internal thoracic artery: results of a randomised longitudinal trial. J Thorac Cardiothorac Surg 2006;132:373-378.[Abstract/Free Full Text]




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