Abstract
ObjectiveThe aim of this study was to compare the efficacy of two different papaverine concentrations (0.5 mg/ml and 2 mg/ml) for vasospasm prevention and their impact on endothelium integrity.MethodsWe have studied distal segments of radial arteries obtained by no-touch technique from coronary artery bypass graft (CABG) patients (n=10). The vasodilatory effect of papaverine (concentrations of 0.5 mg/ml and 2 mg/ml) was assessed in vitro, in isometric tension studies using ex vivo myography (organ bath technique) and arterial rings precontracted with potassium chloride (KCl) and phenylephrine. The impact of papaverine on endothelial integrity was studied by measurement of the percentage of vessel's circumference revealing CD34 endothelial marker.Results2 mg/ml papaverine concentration showed stronger vasodilatatory effect than 0.5 mg/ml, but it caused significantly higher endothelial damage. Response to KCl was 7.35±3.33 mN for vessels protected with papaverine 0.5 mg/ml and 2.66±1.96 mN when papaverine in concentration of 2 mg/ml was used. The histological examination revealed a significant difference in the presence of undamaged endothelium between vessels incubated in papaverine 0.5 mg/ml (72.86±9.3%) and 2 mg/ml (50.23±13.42%), P=0.002.ConclusionPapaverine 2 mg/ml caused the higher endothelial damage. Concentration of 0.5 mg/ml caused better preservation of the endothelial lining.
Highlights
Coronary artery bypass graft (CABG) surgery is the most common cardiac surgical procedure that presents long term efficacy and durability with reduced mortality and morbidity observed in the last decade[1,2,3]
We have evaluated the impact of the examined papaverine concentration on endothelial integrity by calculating the percentage of vessel’s circumference lined by endothelial cells, as revealed by immunofluorescence of their CD34 marker
PW Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; final approval of the version to be published
Summary
Coronary artery bypass graft (CABG) surgery is the most common cardiac surgical procedure that presents long term efficacy and durability with reduced mortality and morbidity observed in the last decade[1,2,3]. Left internal mammary artery (LIMA) has been routinely applied in CABG surgery as “first conduit of choice” because of its resistance to atherosclerosis, especially in older patients[4]. Radial artery (RA) is rarely used as a conduit in CABG surgery, mainly because of its high tendency to vasospasm. The durability of RA as an arterial conduit is satisfactory: according to Acar et al.[5], patency rates were 93% after 9 months and 89% after 2 years. RA shows higher failure rates when grafted to right coronary artery (RCA) system than to left artery descending (LAD) system. The failures should rather be attributed to the coronary artery than to the RA conduit because of the higher intensity of atherosclerosis in RCA[6]
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