Normothermia is the Key for the Treatment of Internal Thoracic Artery Spasm

Authors

  • Ibrahim Arif Tarhan
  • Tamer Kehlibar
  • Mehmet Yilmaz
  • Yucesin Arslan
  • Mert Dumantepe
  • Kazim Berkoz
  • Cansin Pancaroglu
  • Azmi Özler

DOI:

https://doi.org/10.1532/HSF98.20061211

Abstract

Background. Free flow of the internal thoracic artery decreases commonly after harvesting because of spasm. Tissue heat loss is inevitable during surgery. The aim of this study was to compare the internal thoracic artery pedicle rewarming method with topical papaverine applications in different thermal conditions.

Methods. Patients (n = 120) were organized in to 6 equally sized groups. The effects of topical papaverine application at room temperature, topical heated papaverine (at 37°C) application, internal thoracic artery pedicle storage in normothermic conditions, pedicle storage in normothermic conditions combined with topical papaverine application, and pedicle storage in normothermic conditions combined with topical heated papaverine application were investigated. In the control group, no treatment was applied and the pedicle was stored in room temperature conditions. We measured internal thoracic artery free flows at 3 stages: at the initiation of harvesting, after total harvesting, and after antispasmodic treatment. Durations of the stages were recorded. At each stage hemodynamic parameters, tissue and core temperatures were also monitored.

Results. Internal thoracic artery pedicle temperature significantly decreased simultaneously with the free flow after the harvesting procedure. Recovery of the physiologic temperature state, provided by storing the internal thoracic artery pedicle in normothermic conditions, improved the flow and increased the efficiency of topically applied papaverine on the vasospasm of the internal thoracic artery.

Conclusion. Topical application of heated papaverine itself does not warm pedicle tissue, but papaverine efficiency increases when the pedicle is stored in normothermic conditions. Preserving internal thoracic artery pedicles in normothermic conditions can be the preferred treatment for spasms.

References

Athanasiou T, Crossman MC, Asimakopoulos G, et al. 2004. Should the internal thoracic artery be skeletonized? Ann Thorac Surg 77:2238-46.nBilgen F, Yapici MF, Serbetçioglu A, et al. 1996. Effect of normothermic papaverine to relieve intraoperative spasm of the internal thoracic artery. Ann Thorac Surg 62:769-71.nCooper GJ, Wilkinson AL, Angelini GD. 1992. Overcoming perioperative spasm of the internal mammary artery. Which is the best vasodilator? J Thorac Cardiovasc Surg 104:465-8.nDeja MA, Golba KS, Malinowski M, et al. 2005. Skeletonization of internal thoracic artery affects its innervation and reactivity. Eur J Cardiothorac Surg 28:551-7.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.nFlavahan NA, Lindblad LE, Verbeuren TJ, Shepherd JT, Vanhoutte PM. 1985. Cooling and alpha1- and alpha2-adrenergic responses in cutaneous veins: fole of receptor reserve. Am J Physiol 249:H950-5.nFormica F, Ferro O, Brustia M, et al. 2006. Effects of papaverine and glycerilnitrate-verapamil solution as topical and intraluminal vasodilators for internal thoracic artery. Ann Thorac Surg 81:120-4.nGao YJ, Zeng ZH, Teoh K, et al. 2005. Perivascular adipose tissue modulates vascular function in the human internal thoracic artery. J Thorac Cardiovasc Surg 130:1130-6.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.nHarker CT, Vanhoutte PM. 1988. Cooling the central ear artery of the rabbit: myogenic and adrenergic responses. J Pharmacol Exp Ther 245:89-93.nHarker CT, Ousley PJ, Harris EJ, et al. 1990. The effects of cooling on human saphenous vein reactivity to adrenergic agonists. J Vasc Surg 12:45-9.nHarker CT, Ousley PJ, Bowman CJ, Porter JM. 1991. Cooling augments alpha2-adrenoceptor-mediated contractions in rat tail artery. Am J Physiol 260:H1166-71.nHarker CT, Taylor LM Jr, Porter JM. 1991. Vascular contractions to serotonin are augmented by cooling. J Cardiovasc Pharmacol 18:791-6.nHe GW, Buxton BF, Rosenfeldt FL, Angus JA, Tatoulis J. 1994. Pharmacologic dilatation of the internal mammary artery during coronary bypass grafting. J Thorac Cardiovasc Surg 107:1440-7.nJones EL, Lattouf OM, Weintraub WS. 1989. Catastrophic consequences of internal mammary hypoperfusion. J Thorac Cardiovasc Surg 98:902-7.nRosenfeldt FL, He GW, Buxton BF, Angus JA. 1999. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg 67:878-88.nSasson L, Cohen AJ, Hauptman E, Schachner. 1995. Effect of topical vasodilators on internal mammary arteries. Ann Thorac Surg 59:494-6.nSessler DI. 2000. Perioperative heat balance. Anesthesiology 92:578-96.nTakami Y, Ina H. 2002. Effects of skeletonization on intraoperative flow and anastomosis diameter of internal thoracic arteries in coronary artery bypass grafting. Ann Thorac Surg 73:1441-5.nTarhan IA, Kehlibar T, Yapici F, et al. 2006. Efficacy of physiologic temperature on the spasm of harvested radial artery. Heart Surg Forum 9:E765-9.nTarhan A, Kehlibar T, Yapici F. 2006. Role of physiological state ‘normothermia’ in internal thoracic artery spasm after harvesting. Eur J Cardiothorac Surg 30:749-52.nVan Son JAM, Tavilla G, Noyez L. 1992. Detrimental squeal on the wall of the internal mammary artery caused by hydrostatic dilation with diluted papaverine solution. J Thorac Cardiovasc Surg 104:972-6.nYamamoto R, Cline WH Jr, Takasaki K. 1989. Effect of moderate cooling endogenous norepinephrine release from the mesenteric vasculature of rats. J Auton Pharmacol 9:347-55.nYamamoto R, Takasaki K, Nickols GA. 1992. Purinergic vasoconstrictor component revealed by moderate cooling in the isolated mesenteric vasculature of Sprague-Dawley rats. J Pharmacol Exp Ther 262:1133-8.nYamamoto R, Wada A, Asada Y, et al. 1997. Nitric oxide-dependent and independent norepinephrine release in rat mesenteric arteries. Am J Physiol 272:H207-10.nYavuz S, Celkan A, Göncü T, Türk T, Ozdemir A. 2001. Effect of papaverine applications on blood flow of the internal mammary artery. Ann Thorac Cardiovasc Surg 7:84-8.n

Published

2007-03-27

How to Cite

Tarhan, I. A., Kehlibar, T., Yilmaz, M., Arslan, Y., Dumantepe, M., Berkoz, K., Pancaroglu, C., & Özler, A. (2007). Normothermia is the Key for the Treatment of Internal Thoracic Artery Spasm. The Heart Surgery Forum, 10(3), E180-E185. https://doi.org/10.1532/HSF98.20061211

Issue

Section

Article