Pressure applied during surgery alters the biomechanical properties of human saphenous vein graft

Necla Ozturk, Nehir Sucu, Ulku Comelekoglu, Banu Coskun Yilmaz, Barlas Naim Aytacoglu, Ozden Vezir

Pressure applied during harvesting of the saphenous vein (SV) graft in coronary artery bypass surgery might change its mechanical properties and thereby decrease the patency. This study was performed to assess the mechanical properties of the SV graft distended manually with different levels of pressure and to determine the pressure level that induces changes in its structure and mechanics. Saphenous vein graft segments, collected from 36 patients undergoing coronary artery bypass surgery, were distended with pressures of either 50-60, 75-100, or 130-150 mmHg. Grafts were tested for the stress-strain relationship; the Young's moduli at the low- and high-strain regions were calculated, and their structures were examined by light and electron microscopy. Pressures of 50-60 mmHg did not influence the mechanics of the vein graft, whereas pressures of 75-100 mmHg elevated the elastic modulus of the vein at the low-strain region while pressures above 130 mmHg increased the elastic moduli at both low- and high-strain regions. There was a prominent loss of microfibrils at all distending pressure levels. The mechanical results suggest that distending pressures above 75 mmHg might play a role in graft failure. Furthermore, the absence of microfibrils surrounding elastin suggests that application of distending pressures, even as low as 50 mmHg, can cause degeneration of the elastic fibers following implantation, increasing the stiffness of the graft and thus impairing the graft's function under its new hemodynamic conditions.