title: Fasudil Is an Effective Graft Vasodilator for Gastroepiploic Artery in Coronary Artery Bypass Grafting.
abstract: OBJECTIVE
  The gastroepiploic artery (GEA) has been used as an alternative arterial in situ graft for coronary artery bypass grafting (CABG). However, because of the large individual differences and the spastic nature of the GEA, caution has to be exercised during harvesting. We evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a vasodilator for right GEA (RGEA) graft after harvesting, compared with the conventional agents papaverine and verapamil-nitroglycerin.
  
  
  METHODS
  Between June 2009 and January 2013, 30 patients with ischemic heart disease who underwent isolated CABG using RGEA graft were randomly assigned to fasudil (n = 10), papaverine (n = 10), or verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine (1.0 mmol/L) mixed with heparinized blood, or verapamil-nitroglycerin (30 μmol/L each) was injected intraluminally into the RGEA graft after harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and histopathology of RGEA were evaluated.
  
  
  RESULTS
  Intraluminal injection of fasudil increased GFF significantly (P < 0.001) and markedly from 41.5 ± 31.5 mL/min at baseline to 149.3 ± 46.7 mL/min after injection. Papaverine increased GFF (P < 0.001) from 40.0 ± 35.8 to 64.9 ± 33.7 mL/min, and verapamil-nitroglycerin also increased GFF (P < 0.001) from 38.8 ± 32.1 to 79.0 ± 35.2 mL/min. The GFF was significantly higher (P = 0.001) in the fasudil group than in the other two groups. Histopathologically, fasudil treatment markedly increased the diameter of RGEA graft, while maintaining integrity of the multiple elastic lamellae. Blood pressure did not change significantly after drug injection in all groups.
  
  
  CONCLUSIONS
  Fasudil is more potent than papaverine or verapamil-nitroglycerin in increasing GFF of RGEA graft for CABG.
authors.affiliation: From the Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Watanabe
authors.forename: Shojiro
authors.initials: S
authors.lastname: Yamaguchi
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tomita
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishida
mesh_terms: D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000368:Aged; D001026:Coronary Artery Bypass / Q000592:standards; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods; D005260:Female; D024405:Gastroepiploic Artery / Q000601:surgery / Q000637:transplantation*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery; D005996:Nitroglycerin / Q000008:administration & dosage; D010208:Papaverine / Q000008:administration & dosage; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014700:Verapamil / Q000008:administration & dosage / Q000494:pharmacology; D054460:rho-Associated Kinases / Q000037:antagonists & inhibitors*
chemical_list: D047428:Protein Kinase Inhibitors; D014665:Vasodilator Agents; D019307:1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine; D014700:Verapamil; D010208:Papaverine; D054460:rho-Associated Kinases; D005996:Nitroglycerin; C049347:fasudil