Efficacy of Physiologic Temperature on the Spasm of Harvested Radial Artery
DOI:
https://doi.org/10.1532/HSF98.20051002Abstract
Background. The potential disadvantage of using the radial artery for coronary artery bypass grafting is its increased tendency to vasospasm. Therefore, different antispastic agents are being used in the perioperative and postoperative period. During the preparation of the radial artery, normal local and systemic temperatures are lost.
Methods. We investigated the effects of topical normal saline solution at 20°C (group SI), normal saline solution at 36°C (group SII), diltiazem at 20°C (group DI), and diltiazem at 36°C (group DII) on radial artery free flow. Each group contained 10 patients undergoing coronary bypass surgery. Free flow and local temperature were measured at 3 stages: after the exploration and preparation of the distal 3 cm of the radial artery, after total preparation of the radial artery, and a median of 12 minutes after the pedicle had been sprayed with one of the agents.
Results. Parallel to the significant decrease of the second local temperatures (P < .001), the second flow of the 4 groups decreased significantly (P < .001).
Conclusion. Hypothermia plays an important role in radial artery vasospasm, and normothermia may be the best perioperative vasodilating agent since the normal radial artery flows were reached with normothermia.
References
Acar C, Jebara VA, Portoghese M, et al. 1992. Revival of the radial artery for coronary artery bypasses grafting. Ann Thorac Surg 54:652-9.nBrodman RF, Frame R, Camacho M, Hu E, Chen A, Hollinger I. 1996. Routine use of unilateral and bilateral radial arteries for coronary artery bypass graft surgery. J Am Coll Cardiol 28:959-63.nBuxton B, Windsor M, Komeda M, Gaer J, Fuller J, Liu J. 1997. How good is the radial artery as a bypass graft? Coronary Artery Dis 8:225-33.nCarpentier A, Guermonprez JL, Deloche A, Frechette C, Dubost C. 1973. The aorta-to-coronary radial artery bypass graft: a technique avoiding pathological changes in grafts. Ann Thorac Surg 16:111-21.nChanda J, Brichkov I, Canver CC. 2000. Prevention of radial artery graft vasospasm after coronary bypass. Ann Thorac Surg 70:2070-4.nDietl CA, Benoit CH. 1995. Radial artery graft for coronary revascularization: technical considerations. Ann Thorac Surg 60:102-10.nDipp MA, Nye PCG, Taggart DP. 2001. Phenoxybenzamine is more effective and less harmful than papaverine in the prevention of radial artery vasospasm. Eur J Cardiothorac Surg 19:482-6.nFremes SE, Christakis GT, Del Rizzo DF, et al. 1995. The technique of radial artery bypass grafting and early clinical results. J Cardiac Surg 10:537-44.nHe GW, Yang CQ. 1996. Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting. Ann Thorac Surg 61:610-4.nHe GW, Yang CQ. 2000. Comparative study on calcium channel antagonists in the human radial artery: clinical implications. J Thorac Cardiovasc Surg 119:94-100.nLoop FD, Lytle BW, Cosgrove DM, et al. 1986. Influence of the internal mammary artery graft on 10-year survival and other cardiac events. New Eng J Med 314:1-6.nManasse E, Sperti G, Suma H, et al. 1996. Use of the radial artery for myocardial revascularization. Ann Thorac Surg 62:1076-82.nMuneretto C, Negri A, Manfredi J, et al. 2003. Safety and usefulness of composite grafts for total arterial myocardial revascularization: a prospective randomized evaluation. J Thorac Cardiovasc Surg 125:826-35.nOkies JE, Page VS, Bigelow JC, Krause AH, Salomon NW. 1984. The left internal mammary artery. The graft of choice. Circulation 70:213-21.nReyes AT, Frame R, Brodman RF. 1995. Technique for harvesting the radial artery as a coronary artery bypass graft. Ann Thorac Surg 59:118-26.nRosenfeldt FL, He GH, Buxton BF, Angus JA. 1999. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg 67:878-88.nSessler DI. 2000. Perioperative heat balance. Anesthesiology 92:578-96.nShapira I, Isakov A, Heller I, et al. 1999. Long term follow-up after coronary artery bypass grafting reoperation. Chest 115:1593-7.nSones EL, Lutz JF, King SB, Powelson S, Knolpf W. 1986. Extended use of the internal mammary artery graft. Important anatomic and physiological considerations. Circulation 74:III42-7.nTatoulis J, Royse AG, Buxton BF, et al. 2002. The radial artery in coronary surgery: a 5-year experience-clinical and angiographic results. Ann Thorac Surg 73:143-8.nVelez DA, Morris CD, Muraki S, et al. 2001. Brief pretreatment of radial artery conduits with phenoxybenzamine prevents vasoconstriction long term. Ann Thorac Surg 72:1977-84.nWeinschelbaum EE, Gabe ED, Macchia A, Smimmo R, Suarez LD. 1997. Total myocardial revascularization with arterial conduits: radial artery combined with internal thoracic arteries. J Thorac Cardiovasc Surg 114:911-6.n