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Eur J Cardiothorac Surg 2004;25:560-566
© 2004 Elsevier Science NL

Arterial endothelial denudation by intraluminal use of papaverine–NaCl solution in coronary bypass surgery

^a Wihuri Research Institute, Kalliolinnantie 4, 00140 Helsinki, Finland
^b Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
^c Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Helsinki, Finland
^d Electron Microscopy Unit, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
^e Institute of Anatomy, Histology and Embryology, University of Innsbruck, Innsbruck, Austria

Received 14 October 2003; received in revised form 22 December 2003; accepted 9 January 2004.

^* Corresponding author. Tel.: +358-9-681-411; fax: +358-9-637-476
e-mail: petri.kovanen{at}wri.fi

Objectives: Preservation of endothelial integrity during coronary artery bypass grafting is considered important for short- and long-term patency of the graft. In current literature there are controversial data about the safety of papaverine, a vasorelaxant widely used in coronary artery bypass grafting. Accordingly, we examined the immediate effects of papaverine on the endothelial morphology of arterial grafts and on viability of cultured human coronary artery endothelial cells. Methods: Totally 22 segments of the radial artery were collected from 11 patients undergoing coronary artery bypass grafting. The segments were cut from the distal redundant parts of the arteries, which were not required for bypass grafting. A small distal segment of the artery was excised and placed into autologous heparinized whole blood (control segment). The rest of the graft, still remaining proximally attached to the circulation, was treated intraluminally with papaverine–NaCl solution (pH 4.2) for 5 min, after which another small distal segment was excised for the study (papaverine-treated segment). Segments were then perfusion-fixed and the endothelial surface was examined by scanning electron microscopy. Endothelial denudation was assessed and its severity graded. Additionally, viability of cultured human coronary artery endothelial cells after treatment with papaverine was assessed with trypan blue staining. Results: Treatment with papaverine solution markedly increased the endothelial denudation (grades from 6.2±1.7 to 10.0±3.5; mean±SD; P=0.004). Papaverine-treatment increased trypan blue staining of cultured human coronary artery endothelial cells regardless of papaverine diluent (normal saline of pH 4.5 or 7.4 or blood). Conclusions: Treatment of arterial grafts with papaverine solutions apparently damages endothelial cells. Thus, the clinical practice of dilating arterial bypass grafts with papaverine should be reassessed, and alternative methods of vasodilatation should be considered.

Key Words: Complications of surgery • Coronary artery bypass conduits • Coronary artery bypass surgery • Endothelium

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