Effects of Pretreatment with Different Topical Vasodilators on Blood Flow in the Internal Mammary Artery: A Prospective Randomized Study

Authors

  • Bektas Battaloglu
  • Vedat Nisanoglu
  • Nevzat Erdil
  • Bulent Ozgur
  • Tamer Eroglu
  • Nihat Aydin
  • Murat Kaynak
  • Serkan Secici

DOI:

https://doi.org/10.1532/HSF98.20061166

Abstract

Background. This study was conducted to investigate how brief pretreatments with 4 different vasodilators applied topically at normal body temperature affect blood flow in the internal mammary artery.

Methods. One hundred patients who had an internal mammary artery mobilized as a pedicle for coronary artery bypass grafting were randomly assigned to one of 5 groups of equal size (20 subjects in each). Each group of pedicles was treated with a different topical solution: normal saline (control), nitroglycerin, diltiazem, papaverine, or adenosine. Internal mammary artery flow and hemodynamic measurements were recorded immediately after harvesting and after 5 minutes of immersion in a tube filled with test solution (50 mL at 37°C). Results for each study variable were compared within and between groups, and posttreatment-to-pretreatment ratios were also calculated and compared.

Results. All 4 vasodilator groups showed a significant increase in internal mammary artery flow rate from pretreatment to posttreatment, whereas the saline group did not. There were no significant differences among the 5 groups' pretreatment flow rates (P = .526) or posttreatment flow rates (P = .194). The mean ratio values (posttreatmentto-pretreatment) for flow rate were 1.08 ± 0.17 in the saline group, 1.74 ± 0.17 with nitroglycerin, 1.77 ± 0.49 with diltiazem, 1.82 ± 0.59 with papaverine, and 1.57 ± 0.54 with adenosine. Post hoc analysis revealed that the mean ratio values for flow rate in the 4 vasodilator groups were significantly higher than the corresponding ratio in the saline group.

Conclusions. Brief treatment of the internal mammary artery with topical vasodilators at normal body temperature significantly increases blood flow in this vessel. The data from this study are particularly valuable in relation to off-pump surgery, in which this vessel is usually anastomosed soon after it is harvested.

References

Bilgen F, Yapici MF, Serbetcioglu A, Tarhan IA, Coruh T, Ozler A. 1996. Effect of normothermic papaverine to relieve intraoperative spasm of the internal thoracic artery. Ann Thorac Surg 62:769-71.nCanzer CC, Dame NA. 1994. Ultrasonic assessment of internal thoracic artery graft flow in the revascularized heart. Ann Thorac Surg 58:135-8.nCooper GJ, Wilkinson GA, Angelini GD. 1992. Overcoming perioperative spasm of the internal mammary artery: which is the best vasodilator? J Thorac Cardiovasc Surg 104:465-8.nDregelid E, Heldal K, Anderson KS, Strangeland L, Svendsen E. 1993. Dilation of the internal mammary artery by external papaverine application to the pedicle-an improved method. Eur J Cardiothorac Surg 7:158-63.nDregelid E, Heldal K, Resch F, Strangeland L, Breivik K, Svendsen E. 1995. Dilation of the internal mammary artery by external and intraluminal papaverine application. J Thorac Cardiovasc Surg 110:697-703.nFormica F, Ferro O, Brustia M, et al. 2006. Effects of papaverine and glycerylnitrate-verapamil solution as topical and intraluminal vasodilators for internal thoracic artery. Ann Thorac Surg 81:120-4.nFrierson JH, Bigelow JC, Duke DJ, Mahoney TM, Dimas AP. 1993. Treatment of perioperative mammary artery spasm with nifedipine. Am Heart J 125:884-6.nGirard DS, Sutton JP 3rd, Williams TH, et al. 2004. Papaverine delivery to the internal mammary artery pedicle effectively treats spasm. Ann Thorac Surg 78:1295-8.nHausmann H, Photiadis J, Hetzer R. 1996. Blood flow in the internal mammary artery after the administration of papaverine during coronary artery bypass grafting. Tex Heart Inst J 23:279-83.nHennessy TG, Codd MB, Donnelly S, et al. 1998. Long-term clinical outcome following coronary artery bypass grafting for isolated stenosis of the left anterior descending coronary artery. Eur Heart J 19:447-57.nJett GK, Guyton RA, Hatcher CR Jr, Abel PW. 1992. Inhibition of human internal mammary artery contractions. An in vitro study of vasodilators. J Thorac Cardiovasc Surg 104:977-82.nJones EL, Lattouf OM, Weintraub WS. 1989. Catastrophic consequences of internal mammary hypoperfusion. J Thorac Cardiovasc Surg 98:902-7.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 314:1-6.nLytle BW, Loop FD, Cosgrove DM, Ratliff NB, Easley K, Taylor PC. 1985. Long-term (5 to 12 years) serial studies of internal mammary artery and saphenous vein coronary bypass grafts. J Thorac Cardiovasc Surg 89:248-58.nMagee MJ, Edgerton JR. 2003. Beating heart coronary artery bypass: operative strategy and technique. Semin Thorac Cardiovasc Surg 15:83-91.nMills NL, Bringaze WL 3rd. 1989. Preparation of the internal mammary artery graft. Which is the best method? J Thorac Cardiovasc Surg 98:73-7.nNili M, Stamler A, Sulkes J, Vidne BA. 1999. Preparation of the internal thoracic artery by vasodilator drugs: is it really necessary? A randomized double-blind placebo-controlled clinical study. Eur J Cardiothorac Surg 16:560-3.nRizzoli G, Schiavon L, Bellini P. 2002. Does the use of bilateral internal mammary artery (IMA) grafts provide incremental benefit relative to the use of a single IMA graft? A meta-analysis approach. Eur J Cardiothorac Surg 22:781-6.nRosenfeldt FL, He GW, Buxton BF, Angus JA. 1999. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg 67:878-88.nSarabu MR, McClung JA, Fass A, Reed GE. 1987. Early postoperative spasm in left internal mammary bypass grafts. Ann Thorac Surg 44:199-200.nSasson L, Cohen AJ, Hauptman E, Schachner A. 1995. Effect of topical vasodilators on internal mammary arteries. Ann Thorac Surg 59:494-6.nTatoulis J, Buxton BF, Fuller JA, Royce AG. 1999. Total arterial coronary revascularization: techniques and results in 3,220 patients. Ann Thorac Surg 6:2093-9.nVan Son JA, Smedts F, Vincent JG, Van Lier HJ, Kubat K. 1990. Comparative anatomic studies of various arterial conduits for myocardial revascularization. J Thorac Cardiovasc Surg 99:703-7.nVilandt J, Kjaergard H, Aggestrup S, Andreasen JJ, Olesen A. 1999. Intraluminal papaverine with pH 3 doubles blood flow in the internal mammary artery. Scand Cardiovasc J 33:330-2.n

Published

2007-02-21

How to Cite

Battaloglu, B., Nisanoglu, V., Erdil, N., Ozgur, B., Eroglu, T., Aydin, N., Kaynak, M., & Secici, S. (2007). Effects of Pretreatment with Different Topical Vasodilators on Blood Flow in the Internal Mammary Artery: A Prospective Randomized Study. The Heart Surgery Forum, 10(2), E136-E140. https://doi.org/10.1532/HSF98.20061166

Issue

Section

Articles