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

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.