Korean J Thorac Cardiovasc Surg.  2013 Dec;46(6):413-425.

Nafamostat Mesilate: Can It Be Used as a Conduit Preserving Agent in Coronary Artery Bypass Surgery?

• Yoon YS
• Oh H
• Kim Y
• Lim SP
• Kim CS
• Kang MW

Abstract

BACKGROUND
Graft vessel preservation solution in coronary artery bypass surgery is used to maintain the graft conduit in optimal condition during the perioperative period. Nafamostat mesilate (NM) has anticoagulation and anti-inflammatory properties. Therefore, we investigated NM as a conduit preservative agent and compared it to papaverine.
METHODS
Sprague-Dawley (SD) rat thoracic aortas were examined for their contraction-relaxation ability using phenylephrine (PE) and acetylcholine (ACh) following preincubation with papaverine and NM in standard classical organ baths. Human umbilical vein endothelial cells (HUVECs) were cultured to check for the endothelial cell viability. Histopathological examination and terminal deoxynucleotidyl transferase dUTP nick end labeling assay were performed on the thoracic aortas of SD rats.
RESULTS
The anti-contraction effects of papaverine were superior to those of NM at PE (p<0.05). The relaxation effect of NM on ACh-induced vasodilatation was not statistically different from that of papaverine. Viability assays using HUVECs showed endothelial cell survival rates of >90% in various concentrations of both NM and papaverine. A histopathological study showed a protective effect against necrosis and apoptosis (p<0.05) in the NM group.
CONCLUSION
NM exhibited good vascular relaxation and a reasonable anti-vasocontraction effect with a better cell protecting effect than papaverine; therefore, we concluded that NM is a good potential conduit preserving agent.

Keyword

Coronary artery bypass surgery; Coronary artery bypass conduits; Anticoagulants

MeSH Terms

Acetylcholine
Animals
Anticoagulants
Aorta, Thoracic
Apoptosis
Baths
Coronary Artery Bypass*
Coronary Vessels*
DNA Nucleotidylexotransferase
Endothelial Cells
Guanidines
Human Umbilical Vein Endothelial Cells
Mesylates*
Necrosis
Papaverine
Perioperative Period
Phenylephrine
Rats
Rats, Sprague-Dawley
Relaxation
Survival Rate
Transplants
Vasodilation
Acetylcholine
Anticoagulants
DNA Nucleotidylexotransferase
Guanidines
Mesylates
Papaverine
Phenylephrine