Koroner arter baypas greftleme yapılan hastalarda yaşın internal torasik arterdeki ultrastrüktürel değişiklikler üzerine etkisi

Year 2024, Volume: 15 Issue: 3, 419 - 425, 30.09.2024

Şafak Alpat , Timuçin Sabuncu , Ahmet Aydın , Oktay Peker , Murat Güvener , Mustafa Yılmaz

https://doi.org/10.18663/tjcl.1536540

Abstract

Amaç: Yaş, kardiyovasküler hastalık için bilinen bir risk faktörüdür ve aterosklerotik süreçte rol oynar. Bu çalışmanın amacı, koroner arter baypas greftlemesi yapılan hastalarda yaşlanmanın ve ilişkili risk faktörlerinin internal torasik arterlerin altyapısı üzerindeki etkisini incelemektir.
Gereç ve Yöntemler: Ağustos-Ekim 2018 tarihleri arasında birimimizde elektif koroner arter bypass ameliyatı geçiren 27 hasta çalışmaya dahil edildi. Yaş aralıkları 50-59, 60-69 ve 70-79 olmak üzere üç gruba ayrıldı. ITA cerrahi olarak çıkarıldığında damarın 2 mm'lik distal kısmı eksize edildi. Ultrastrüktürel değişiklikleri araştırmak için transmisyon elektron mikroskobu kullanıldı. Hücre yapısı, doku ödemi ve endotelyal mitokondri yarı kantitatif analiz kullanılarak değerlendirildi ve derecelendirildi.
Bulgular: Grup-I'de damar duvarında ultrastrüktürel anlamlı bir değişiklik görülmedi. Grup-II'de değişen kalınlıklarda endotel hücreleri içeren endotel duvar düzensizliği görüldü. Grup-III'de subendotelyal ödem ve lokalize endotel duvar süreksizliği görüldü. Bu değişiklikler özellikle yaşlılarda ve eşlik eden hastalıkları olan hastalarda şiddetliydi. Büyük vakuoller ve organel kaybı gibi en büyük kalıcı hücre değişiklikleri, böbrek yetmezliği ve hipertansiyonu olan iki hastada tespit edildi. Endotelyal hücre yapısındaki (P = 0,001), doku ödemi (P = 0,001) ve mitokondrideki (P = 0,001) değişikliklerin ciddiyetini değerlendiren ortalama puanlar, yaşlanmayla birlikte daha ciddi değişiklikler gösteren gruplar arasında anlamlı derecede farklıydı.
Sonuç: Eşlik eden hastalıkları olan yaşlı hastalarda, ITA endoteli ciddi yapısal değişiklikler sergileyebilir; en kalıcı anormallikler hipertansiyon ve böbrek yetmezliği olanlarda rapor edilmiştir. Ancak ITA, ateroskleroza karşı doğal direnci nedeniyle KABG'de altın standart olmaya devam etmektedir.

Keywords

İnternal torasik arter, transmisyon electron mikroskobu, koroner arter hastalığı, yaşlanma

Impact of age on ultrastructural changes in internal thoracic artery in patients undergoing coronary artery bypass grafting

Abstract

Aim: Age is a known risk factor for cardiovascular disease and plays a role in the atherosclerotic process. The purpose of this study was to look at the impact of aging and associated risk factors on the ultrastructure of internal thoracic arteries in patients undergoing coronary artery bypass grafting.
Material and Methods: We enrolled 27 patients undergoing elective coronary artery bypass grafting at our institute between August-October 2018. Age groups were classified into three: 50-59, 60-69, and 70-79 years. A 2-mm distal portion of the vessel was excised when the ITA was surgically harvested. Transmission electron microscopy was used to investigate the ultrastructural changes. Cell structure, tissue edema, and endothelial mitochondria were all assessed and rated by using semiquantitative analysis.
Results: The ultrastructure of the vessel wall exhibited no significant changes in Group-I. Endothelial wall irregularity with endothelial cells of varying thickness was seen in Group-II. Group-III showed subendothelial edema and localized endothelial wall discontinuity. These changes were particularly severe in the elderly and patients with comorbidities. The greatest permanent cell alterations, such as massive vacuoles and organelle loss, were identified in two patients with kidney failure and hypertension. The average scores assessing the severity of changes in endotohelial cell structure (P  .001), tissue edema (P  .001), and mitochondria (P  .001) were significantly different between groups showing more severe changes with aging.
Conclusions: In elderly patients with comorbidities, the ITA endothelium may exhibit severe ultrastructural alterations, with the most permanent abnormalities reported in those with hypertension and kidney failure. However, The ITA remains the gold standard in CABG with its native resistance to atherosclerosis.

Keywords

Internal thoracic artery, transmission electron microscopy, coronary artery disease, aging

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