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• W4256543441 abstract "The greater saphenous vein continues to be the most commonly used conduit for coronary artery bypass grafting (CABG). Despite the convenience of saphenous vein grafts (SVGs), the long-term durability remains inferior to arterial grafts, particularly the left internal mammary artery when grafted to the left anterior descending coronary artery. Up to 15% of aortocoronary SVGs are occluded by 1 year after CABG, and approximately 40% of SVGs are occluded at 10 years. In addition, only 50% of patent SVGs at this time point are free of significant stenosis. Saphenous vein graft disease results from three discrete mechanisms: thrombosis, intimal hyperplasia, and atherosclerosis. Early graft failure within 1 month of CABG is primarily due to thrombosis. Intimal hyperplasia, the accumulation of smooth muscle cells and extracellular matrix (ECM) in the intimal compartment, is the major disease process in venous grafts between 1 month and 1 year after bypass grafting. Beyond the first year after CABG, atherosclerosis is the dominant process leading to SVG failure. Multiple predisposing factors for SVG disease have been identified, including cigarette smoking, which has been implicated as an important risk factor for the development of vein graft atheroma. Smoking is also a risk factor for both early and late graft thrombosis. Yongxin and coauthors [1Yongxin S. Wenjun D. Qiang W. Yunqing S. Liming Z. Sheng W.C. Heavy smoking before coronary surgical procedures affects the native matrix metalloproteinase-2 and matrix metalloproteinase-9 gene expression in saphenous vein conduits.Ann Thorac Surg. 2013; 95: 55-61Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar] investigate a potential basic mechanism of vein graft failure after CABG in smokers by studying expression of matrix metalloproteinase (MMP)-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, and TIMP-2 in SVGs among nonsmokers, heavy smokers, and four additional groups who have quit smoking 3, 6, 12 months or longer before surgery. The SVGs were studied at the time of CABG for MMP and TIMP expression at the gene and protein level. MMPs and TIMPs have been shown to have critical roles in vascular remodeling, and increased MMP activity can lead to ECM degradation, smooth muscle cell migration, and matrix reorganization. The results of this study demonstrate that SVG MMP-2 and MMP-9 expression are significantly upregulated and TIMP-1 and TIMP-2 are downregulated in smokers versus all other groups. Interestingly, there is a decline in SVG MMP expression and increased TIMP expression following smoking cessation, but they did not return to nonsmoking levels even after 12 months of not smoking. These data provide preliminary evidence that the balance of MMPs and TIMPs in SVGs is altered by smoking and could have a role in early pathologic vein graft remodeling leading to graft failure. Clinical correlation of SVG MMP and TIMP expression at the time of CABG with short- and long-term graft patency is required to further investigate this hypothesis. Heavy Smoking Before Coronary Surgical Procedures Affects the Native Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 Gene Expression in Saphenous Vein ConduitsThe Annals of Thoracic SurgeryVol. 95Issue 1PreviewSmoking has numerous effects that may promote atherosclerosis, but the pathogenesis of smoking-related vein graft disease after coronary artery bypass grafting (CABG) remains incompletely understood. Matrix metalloproteinase (MMP) subtypes MMP-2 and MMP-9 have been identified as the key components in vascular remodeling processes. However little is known about the native MMP2 and MMP9 gene expression in saphenous vein (SV) conduits of heavy smokers undergoing CABG. Full-Text PDF" @default.
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• W4256543441 date "2013-01-01" @default.
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• W4256543441 title "Invited Commentary" @default.
• W4256543441 doi "https://doi.org/10.1016/j.athoracsur.2012.09.001" @default.
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