Horm Metab Res 2023; 55(01): 65-74
DOI: 10.1055/a-1984-0255
Original Article: Endocrine Research

Aprotinin does not Impair Vascular Function in Patients Undergoing Coronary Artery Bypass Graft Surgery

Josephine Tolkmitt
1   Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
Heike Brendel
1   Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
Birgit Zatschler
2   Institute of Physiology, Technische Universität Dresden, Dresden, Germany
Stefan Brose
3   Department of Cardiac Surgery, University Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
Coy Brunssen
4   Division of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
Irakli Kopaliani
2   Institute of Physiology, Technische Universität Dresden, Dresden, Germany
Andreas Deussen
2   Institute of Physiology, Technische Universität Dresden, Dresden, Germany
Klaus Matschke
3   Department of Cardiac Surgery, University Heart Center Dresden, Technische Universität Dresden, Dresden, Germany
Henning Morawietz
1   Department of Medicine III, Division of Vascular Endothelium and Microcirculation, Technische Universität Dresden, Dresden, Germany
› Author Affiliations
Funding Information Else Kröner-Fresenius-Stiftung — http://dx.doi.org/10.13039/ 501100003042; 2010_A105; Deutsches Zentrum für Herz-Kreislaufforschung — http://dx.doi.org/10.13039/100010447; 81 × 2800207; Excellence Initiative by the German Federal and State Governments (Institutional Strategy, measure ‘support the best’) — 3–25 2, Grant F-03661–553–41B-1250000; Deutsche Forschungsgemeinschaft — http://dx.doi.org/10.13039/501100001659; 47081312


Bleeding is a major complication in coronary artery bypass graft surgery. Antifibrinolytic agents like serine protease inhibitor aprotinin can decrease postoperative bleeding and complications of cardiac surgery. However, the effects of aprotinin on vascular function are not completely elucidated. We compared the ex vivo vascular function of left internal mammary arteries from patients undergoing coronary artery bypass graft surgery with and without intraoperative application of aprotinin using a Mulvany Myograph. Human internal mammary arteries were treated with aprotinin ex vivo and tested for changes in vascular function. We analyzed the impact of aprotinin on vascular function in rat aortic rings. Finally, impact of aprotinin on expression and activity of endothelial nitric oxide synthase was tested in human endothelial cells. Intraoperative application of aprotinin did not impair ex vivo vascular function of internal mammary arteries of patients undergoing coronary artery bypass graft surgery. Endothelium-dependent and -independent relaxations were not different in patients with or without aprotinin after nitric oxide synthase blockade. A maximum vasorelaxation of 94.5%±11.4vs. 96.1%±5.5% indicated a similar vascular smooth muscle function in both patient groups (n=13 each). Long-term application of aprotinin under physiological condition preserved vascular function of the rat aorta. In vitro application of increasing concentrations of aprotinin on human endothelial cells resulted in a similar expression and activity of endothelial nitric oxide synthase. In conclusion, intraoperative and ex vivo application of aprotinin does not impair the endothelial function in human internal mammary arteries and experimental models.

Publication History

Received: 15 August 2022

Accepted after revision: 14 November 2022

Article published online:
04 January 2023

© 2023. Thieme. All rights reserved.

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