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Chandra R, Heid CA. The Conduit Conundrum: A Commentary on "Outcomes of Radial Artery Versus Saphenous Vein as a Second Conduit After Coronary Artery Bypass Grafting". Am J Cardiol 2024; 217:158-160. [PMID: 38417649 DOI: 10.1016/j.amjcard.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Raghav Chandra
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
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2
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Radial Artery Coronary Bypass Grafting in Heart Failure Patients and Calcium-Channel Blockers. J Am Coll Cardiol 2019; 74:1422-1423. [PMID: 31488279 DOI: 10.1016/j.jacc.2019.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/20/2022]
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3
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Ruel M, Sun LY. Post-Operative Calcium-Channel Blocker Use After Radial Artery Grafting: Do We Now Have a Definitive Answer? J Am Coll Cardiol 2019; 73:2307-2309. [PMID: 31072575 DOI: 10.1016/j.jacc.2019.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
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Ruel M, Voisine P. The Radial Artery Graft: Clinical or Subclinical Benefits? J Am Coll Cardiol 2016; 68:611-613. [PMID: 27491904 DOI: 10.1016/j.jacc.2016.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Ruel
- Department of Cardiac Surgery, University of Ottawa, Ottawa, Canada.
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5
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Hou HT, Wang J, Wang ZQ, Liu XC, Marinko M, Novakovic A, Yang Q, He GW. Effect of Benidipine in Human Internal Mammary Artery and Clinical Implications. Ann Thorac Surg 2016; 101:1789-95. [DOI: 10.1016/j.athoracsur.2015.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/08/2015] [Accepted: 10/12/2015] [Indexed: 01/18/2023]
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6
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Wheeler JB, Mukherjee R, Stroud RE, Jones JA, Ikonomidis JS. Relation of murine thoracic aortic structural and cellular changes with aging to passive and active mechanical properties. J Am Heart Assoc 2015; 4:e001744. [PMID: 25716945 PMCID: PMC4392448 DOI: 10.1161/jaha.114.001744] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/11/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maintenance of the structure and mechanical properties of the thoracic aorta contributes to aortic function and is dependent on the composition of the extracellular matrix and the cellular content within the aortic wall. Age-related alterations in the aorta include changes in cellular content and composition of the extracellular matrix; however, the precise roles of these age-related changes in altering aortic mechanical function are not well understood. METHODS AND RESULTS Thoracic aortic rings from the descending segment were harvested from C57BL/6 mice aged 6 and 21 months. Thoracic aortic diameter and wall thickness were higher in the old mice. Cellular density was reduced in the medial layer of aortas from the old mice; concomitantly, collagen content was higher in old mice, but elastin content was similar between young and old mice. Stress relaxation, an index of compliance, was reduced in aortas from old mice and correlated with collagen fraction. Contractility of the aortic rings following potassium stimulation was reduced in old versus young mice. Furthermore, collagen gel contraction by aortic smooth muscle cells was reduced with age. CONCLUSIONS These results demonstrate that numerous age-related structural changes occurred in the thoracic aorta and were related to alterations in mechanical properties. Aortic contractility decreased with age, likely because of a reduction in medial cell number in addition to a smooth muscle contractile deficit. Together, these unique findings provide evidence that the age-related changes in structure and mechanical function coalesce to provide an aortic substrate that may be predisposed to aortopathies.
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MESH Headings
- Age Factors
- Aging/metabolism
- Aging/pathology
- Animals
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/metabolism
- Aorta, Thoracic/pathology
- Aorta, Thoracic/physiopathology
- Aortic Diseases/etiology
- Aortic Diseases/metabolism
- Aortic Diseases/pathology
- Aortic Diseases/physiopathology
- Collagen/metabolism
- Compliance
- Elastin/metabolism
- Extracellular Matrix/metabolism
- Female
- In Vitro Techniques
- Male
- Mice, Inbred C57BL
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/pathology
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Myocytes, Smooth Muscle/pathology
- Vascular Stiffness
- Vasoconstriction/drug effects
- Vasoconstrictor Agents/pharmacology
- Vasodilation
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Affiliation(s)
- Jason B. Wheeler
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC (J.B.W., R.M., R.E.S., J.A.J., J.S.I.)
| | - Rupak Mukherjee
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC (J.B.W., R.M., R.E.S., J.A.J., J.S.I.)
| | - Robert E. Stroud
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC (J.B.W., R.M., R.E.S., J.A.J., J.S.I.)
| | - Jeffrey A. Jones
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC (J.B.W., R.M., R.E.S., J.A.J., J.S.I.)
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (J.A.J.)
| | - John S. Ikonomidis
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC (J.B.W., R.M., R.E.S., J.A.J., J.S.I.)
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7
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Gao G, Liu XC, Jing WB, Yang Q, He GW. Vasorelaxation Induced by New Third-Generation Dihydropyridine Calcium Antagonist Azelnidipine in Human Internal Mammary Artery. Ann Thorac Surg 2013; 96:1316-1321. [DOI: 10.1016/j.athoracsur.2013.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/08/2013] [Accepted: 05/13/2013] [Indexed: 01/16/2023]
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8
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Buxton B, Hayward PA, Wan S. Invited Commentary. Ann Thorac Surg 2010; 90:1957-8. [DOI: 10.1016/j.athoracsur.2010.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 09/02/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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9
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Effect of Amlodipine in Human Internal Mammary Artery and Clinical Implications. Ann Thorac Surg 2010; 90:1952-7. [DOI: 10.1016/j.athoracsur.2010.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 02/04/2023]
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10
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Pataricza J, Szolnoky J, Krassói I, Hegedus Z, Kun A, Varró A, Papp JG. Vasorelaxing effect of levosimendan against 5-hydroxytryptamine-induced contractions in isolated human conduit bypass grafts. J Pharm Pharmacol 2010; 58:1107-12. [PMID: 16872558 DOI: 10.1211/jpp.58.8.0012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Levosimendan is a novel inodilator drug developed for the treatment of heart failure. The possible vasodilating property of the drug in human coronary artery bypass grafts was investigated. Isometric tensions of the left internal thoracic artery (LITA, n = 8) as well as the proximal and distal segments of the radial artery (RA, n = 8 and 8) were measured in isolated organ baths. Concentration-relaxation curves for levosimendan (0.009-1.14 μmol L−1) were obtained against 5-hydroxytryptamine (5-HT; serotonin, 0.002–9.3 μmol L 1)-induced contractions. 5-HT-induced contraction of LITA was considerably smaller than that of the proximal and distal RAs. Levosimendan relaxed the grafts in the following order of calculated maximum efficacies (Emax): LITA > proximal RA > distal RA (LITA 100.3 ±16.2% of 5-HT-induced maximum tension, proximal RA 86.9 ±8.6%, distal RA 59.4 ± 17.5%, P < 0.05 LITA vs distal RA). The potency values of levosimendan, expressed as the negative logarithm of 50% effective concentrations (pD2), were comparable in the three bypass grafts (LITA −6.52 ± 0.44 log mol L−1, proximal RA −6.60 ± 0.49 log mol L−1, distal RA −6.85 ± 0.45 log mol L−1). The results suggest that levosimendan is an effective vasorelaxant of conduit bypass grafts and may serve as a new therapeutic tool, especially in the case of LITA and proximal RA grafts, for relieving perioperative spasm and subsequent graft failure.
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Affiliation(s)
- János Pataricza
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, Hungary
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11
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Oikawa Y, Matsuno S, Yajima J, Nakamura M, Ono T, Ishiwata S, Fujimoto Y, Aizawa T. Effects of treatment with once-daily nifedipine CR and twice-daily benidipine on prevention of symptomatic attacks in patients with coronary spastic angina pectoris-Adalat Trial vs Coniel in Tokyo against Coronary Spastic Angina (ATTACK CSA). J Cardiol 2010; 55:238-47. [PMID: 20206078 DOI: 10.1016/j.jjcc.2009.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/02/2009] [Accepted: 11/05/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND We compared the efficacy of once-daily treatment with nifedipine CR 40 mg (NR) and twice-daily treatment with benidipine 4 mg (BD) in patients with coronary spastic angina (CSA) registered in 3 cardiovascular institutes in Tokyo. METHODS AND RESULTS CSA was diagnosed by an ischemic ST change during Holter ECG monitoring or drug-induced test. Thirty patients were randomly allocated to either NR or BD group. The number of symptomatic attacks and the total frequency of short-acting nitrates were examined based on the data in diaries written by patients. There were no significant differences in the baseline characteristics between the two groups. The median number (25-75% quartile) of attacks per week was significantly decreased in NR group, i.e., 1.0 (0.8-2.0) at baseline, 0.0 (0.0-1.0) after 4 weeks of treatment, and 0.0 (0.0-0.0) after 8 weeks of treatment (P=0.0093, P=0.0002, Wilcoxon's rank-sum test). No significant decrease was observed in BD, i.e. 1.0 (0.5-2.0) at baseline, 1.3 (0.0-3.0) after 4 weeks, and 0.0 (0.0-1.0) after 8 weeks. The number of attacks was fewer in NR than in BD group (P=0.074, P=0.015, U-test for difference). CONCLUSION Once-daily treatment with NR 40 mg was more effective than twice-daily treatment with BD in the prevention of CSA attacks.
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Affiliation(s)
- Yuji Oikawa
- Cardiovascular Department, The Cardiovascular Institute Hospital, 7-3-10 Roppongi Minato-ku, Tokyo, Japan.
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Lockowandt U, Ritchie A, Grossebener M, Franco-Cereceda A. Endothelin and effects of endothelin‐receptor activation in the mammary and radial artery. SCAND CARDIOVASC J 2009; 38:240-4. [PMID: 15553936 DOI: 10.1080/14017430410031939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the tissue content and endothelin-receptor characteristics of endothelin-1 in the radial artery in relation to the internal mammary artery. DESIGN Endothelin-1 content was quantified in the radial artery and the internal mammary artery. Both arteries were exposed to endothelin-1 and agonists of the endothelin A and B receptors. RESULTS The highest level of endothelin-1 was found in the radial artery. Endothelin-1 contracted both arteries. The contraction was sensitive to endothelinA-receptor agonism and enhanced in both arteries by inhibition of prostacyclin and nitric oxide formation. In the internal mammary artery the endothelinB-receptor agonist caused an endothelinA-receptor sensitive contraction augmented by inhibition of nitric oxide and prostacyclin. However, in the radial artery this contraction was only observed in the presence of inhibition of nitric oxide and prostaglandin. CONCLUSION The highest endothelin-1 content was found in the radial artery. The functional effects of endothelin-1 in the radial artery were similar to that in the internal mammary artery, mediated by predominantly endothelinA-receptor activation causing vasoconstriction. Selective endothelinA-receptor blockade may prove beneficial in preventing graft spasm in the radial as well as the internal mammary artery.
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Affiliation(s)
- Ulf Lockowandt
- Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden.
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Ruddy JM, Jones JA, Stroud RE, Mukherjee R, Spinale FG, Ikonomidis JS. Differential effect of wall tension on matrix metalloproteinase promoter activation in the thoracic aorta. J Surg Res 2009; 160:333-9. [PMID: 19375723 DOI: 10.1016/j.jss.2008.12.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 11/25/2008] [Accepted: 12/22/2008] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vascular remodeling relies upon extracellular matrix restructuring by the matrix metalloproteinases (MMPs). Induction of MMP-2 and MMP-9 by biological signaling molecules has been defined, but whether a mechanical stimulus such as elevated wall tension may generate MMP promoter activation remains unknown. Accordingly, this study examined whether MMP promoter activation would occur as a function of wall tension. MATERIALS AND METHODS The MMP-2 or MMP-9 promoter sequences were fused to the reporter gene lacZ and inserted into the mouse genome. Thoracic aortic rings were harvested (6 preparations/construct) and maintained under physiological conditions at predetermined tension values corresponding to 0, 70, 85, and 100 mm Hg for 3 h. Relative gene expression of lacZ, directly reflecting MMP promoter activity, was then quantified by QPCR. RESULTS MMP-2 promoter activity decreased to 0.42 +/- 0.11 at 0 mm Hg and increased to 1.57 +/- 0.24-fold at 100 mm Hg (P < 0.05), whereas MMP-9 was unaffected. CONCLUSIONS Using unique transgenic constructs with homology to human MMP promoters, this study demonstrated that a physiologically relevant mechanical stimulus was sufficient to differentially induce MMP promoter activation.
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Affiliation(s)
- Jean Marie Ruddy
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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Attaran S, John L, El-Gamel A. Clinical and Potential Use of Pharmacological Agents to Reduce Radial Artery Spasm in Coronary Artery Surgery. Ann Thorac Surg 2008; 85:1483-9. [PMID: 18355566 DOI: 10.1016/j.athoracsur.2007.10.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Revised: 10/09/2007] [Accepted: 10/10/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Saina Attaran
- Department of Cardiothoracic Surgery, Kings College Hospital, London, United Kingdom
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15
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Barner HB. Operative Treatment of Coronary Atherosclerosis. Ann Thorac Surg 2008; 85:1473-82. [DOI: 10.1016/j.athoracsur.2008.01.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 01/06/2023]
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Muriithi EW, Alphonso N, Barnard JB, Hyde JAJ, Pugsley WB, Trivedi UH, Forsyth AT. Early to midterm results with the radial artery in coronary artery bypass grafting following autotransplantation without pharmacological manipulation. J Card Surg 2007; 22:323-7; discussion 328-9. [PMID: 17661775 DOI: 10.1111/j.1540-8191.2007.00415.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In our unit when the radial artery is used as a conduit for myocardial revascularization routine, postoperative calcium-channel blockade is not practised. To preserve the radial artery, it is freed from the surrounding structures together with its venae commitantes and then left, in situ, in circulation, until needed for grafting. We evaluated the early to midterm patency of the radial artery using this strategy in our patients. METHODS We analysed prospectively collected data on 690 consecutive patients who had isolated primary coronary artery bypass grafting performed between June 1999 and February 2003 with at least one conduit being a radial artery. RESULTS Radial arteries were used for 851 of 2150 distal anastomoses (39.6%). Median follow-up was 399 days (range 20-1323) and was 99.9% complete. Early mortality was 2.0% (14). Late mortality was 3.0% (21), 12 late deaths were not cardiac related. Nine patients (1.4%) had angiography on clinical grounds a mean of 238 days (range 0-511) postoperatively. Six coronary artery territories were inadequately supplied by their radial artery grafts. Kaplan-Meier event-free survival was 94% and 90% at 1 and 3 years, respectively. CONCLUSIONS The results of coronary artery bypass grafting using the radial artery in our institution compare favourably with those of other contemporary workers. It is safe to leave the radial artery in situ in the circulation until it is required for grafting. The absence of postoperative pharmacological manipulation of the radial artery does not appear to affect early or midterm outcome.
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Affiliation(s)
- E W Muriithi
- Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, United Kingdom
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Oo AY, Conant AR, Chester MR, Dihmis WC, Simpson AWM. Temperature Changes Stimulate Contraction in the Human Radial Artery and Affect Response to Vasoconstrictors. Ann Thorac Surg 2007; 83:126-32. [PMID: 17184643 DOI: 10.1016/j.athoracsur.2006.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Revised: 08/17/2006] [Accepted: 08/18/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial artery conduits are increasingly used in coronary artery bypass grafting as an additional arterial graft to the internal thoracic artery. Their reactive nature remains a concern, often necessitating the routine use of topically applied vasodilators, such as glyceryl trinitrate, papaverine, phenoxybenzamine, or calcium channel antagonists, in theatre. During preparation prior to surgery and grafting, radial artery conduits are exposed to cooling and rewarming. We investigated how these temperature changes would affect radial artery contractility and how commonly used topical treatments might be used to prevent this. METHODS Human radial artery was obtained excess to surgery and arterial sections used in organ bath tension experiments or for the culture of smooth muscle cells from medial explants. RESULTS The radial artery responded to rapid cooling by the addition of 22 degrees C buffer with contraction. Gradual cooling, over a 20 to 30 minute period, reduced basal tension and the response to potassium chloride (KCl) and noradrenaline. Subsequent rewarming from 22 degrees C to 37 degrees C reestablished contraction at precooled levels and led to an elevation of the basal tension. Increases in tension measured in the radial artery were paralleled by increases in intracellular calcium in smooth muscle cells. Contraction induced by rapid temperature changes could be blocked by glyceryl trinitrate but not by phenoxybenzamine. Papaverine and calcium channel blockers had only limited activity. CONCLUSIONS Temperature changes commonly encountered in theatre during the preparation of radial artery grafts are likely to cause contraction. If rapid temperature change cannot be avoided during graft preparation, then topically applied glyceryl trinitrate will block these responses.
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Affiliation(s)
- Aung Y Oo
- The Cardiothoracic Centre, University of Liverpool, Liverpool, United Kingdom
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Nisanoglu V, Battaloglu B, Ozgur B, Eroglu T, Erdil N. Topical Vasodilators for Preventing Radial Artery Spasm during Harvesting for Coronary Revascularization: Comparison of 4 Agents. Heart Surg Forum 2006; 9:E807-12. [PMID: 16893753 DOI: 10.1532/hsf98.20061070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is still controversy about which vasodilator solution is best for storing radial artery (RA) conduits prior to coronary artery bypass grafting. The aim of this pilot study was to investigate how 4 different topical vasodilators applied during RA harvesting affect blood flow with the vessel in situ. MATERIALS AND METHODS The subjects were 85 patients who underwent RA harvesting in preparation for coronary artery bypass grafting. Each case was assigned to 1 of 5 groups (17 RAs each) that were treated with different solutions: normal saline (control), nitroglycerin, diltiazem, papaverine, and adenosine. Standard clinical concentrations were used. The RA was partially harvested (pedicle attached proximally) and flow rates and hemodynamic parameters (mean arterial pressure, heart rate, central venous pressure) were recorded at 2 time points: (1) pretreatment and (2) after 5 minutes of immersion in 60 mL of treatment solution. Results were compared within and between groups, and post-treatment-to-pretreatment ratios were calculated for each variable. RESULTS There were no significant differences among the groups' mean pretreatment flow rates (P = .979) or mean posttreatment flow rates (P = .069). All except the diltiazem group showed a significant rise in mean flow rate from pretreatment to posttreatment. The mean posttreatment-to-pretreatment ratios for RA flow rate were 1.28 +/- 0.39 in the saline group, 1.85 +/- 0.72 in the nitroglycerin group, 1.31 +/- 0.48 in the diltiazem group, 1.37 +/- 0.64 in the papaverine group, and 1.23 +/- 0.42 in the adenosine group. Only the mean flow ratio in the nitroglycerin group was significantly higher than that in the saline group (P = .003). The mean flow ratios in the other vasodilator groups were not statistically different from the flow ratio in the saline group. CONCLUSIONS These preliminary results indicate that topical application of nitroglycerin solution effectively prevents perioperative spasm of the RA in patients undergoing coronary artery bypass surgery. The authors recommend this solution for preparation and storage of RA grafts. Randomized controlled trials with power analysis will give more definitive information.
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Affiliation(s)
- Vedat Nisanoglu
- Department of Cardiovascular Surgery, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.
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Miwa S, Desai N, Koyama T, Chan E, Cohen EA, Fremes SE. Radial Artery Angiographic String Sign: Clinical Consequences and the Role of Pharmacologic Therapy. Ann Thorac Surg 2006; 81:112-8; discussion 119. [PMID: 16368346 DOI: 10.1016/j.athoracsur.2005.06.076] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Revised: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The radial artery is an increasingly important graft for coronary artery bypass surgery. Postoperative angiographic studies have shown that a proportion of radial grafts become diffusely narrowed but not occluded, or string signs. METHODS Four hundred forty patients receiving a radial artery graft enrolled in a large clinical trial underwent postoperative angiography at 1 year. Angiograms were analyzed visually and quantitatively. A complete string sign was defined as diffuse narrowing along the full length of the graft, while a partial string sign was defined as segmental narrowing. Angiographic findings were correlated with medication compliance and clinical sequelae. RESULTS Thirty-one patients (7.0 %) had radial artery graft string signs versus 4 patients (0.9%) with a saphenous vein graft string sign (p = 0.001). Complete string signs were present in 28 cases, and the mean diameter was 0.76 +/- 0.14 mm (mean +/- SD), whereas 3 cases had a partial string sign with a diameter of 0.89 +/- 0.14 mm. Fifteen radial arteries showed Thrombolysis in Myocardial Infarction Study (TIMI) 1 flow, 3 cases showed TIMI 2 flow, and 13 cases showed TIMI 3 flow. There was no difference in incidence of radial string sign between patients taking nifedipine versus diltiazem postoperatively. Multivariate analysis revealed the presence of radial artery string sign was closely related to the perioperative use of alpha-adrenergic agonists and target vessels stenosis less than 90%. Postoperative symptoms were associated with radial artery string signs with TIMI 1 flow (p = 0.0045). CONCLUSIONS In the Radial Artery Patency Study, radial artery string sign was present in 7% of patients. Despite diffuse narrowing, 52% of grafts had TIMI 2 flow or better.
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Affiliation(s)
- Senri Miwa
- Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
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Manabe S, Sunamori M. Radial Artery Graft for Coronary Artery Bypass Surgery: Biological Characteristics and Clinical Outcome. J Card Surg 2006; 21:102-14; 115. [PMID: 16426364 DOI: 10.1111/j.1540-8191.2006.00182.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The radial artery (RA) is gaining popularity as a bypass conduit for coronary artery bypass grafting, and its impact on clinical practice has been extensively explored. In the present article, we provide a review of postoperative hand circulation, vascular biological characteristics of the RA graft, the efficacy of vasodilator therapies, and mid-term clinical results of use of the RA graft. Fundamental studies revealed excellent vascular biological characteristics of the RA graft as a living arterial conduit, making it almost equivalent to the internal thoracic artery (ITA) graft. Clinical studies have yielded encouraging mid-term results. Most studies reported in favor of the RA graft over the saphenous vein graft with regard to patency rate, freedom from cardiac events, and survival. However, superiority of either the RA or right ITA graft has not been conclusively determined. The long-term results of RA grafts remain unknown, but at present, supplementary use of an RA graft with a left ITA graft appears feasible for CABG.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiothoracic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8519, Japan.
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Gaudino M, Luciani N, Nasso G, Salica A, Canosa C, Possati G. Is postoperative calcium channel blocker therapy needed in patients with radial artery grafts? J Thorac Cardiovasc Surg 2005; 129:532-5. [PMID: 15746735 DOI: 10.1016/j.jtcvs.2004.07.054] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic calcium channel blocker therapy has traditionally been considered necessary in patients carrying a radial artery graft, even in the absence of objective data to support it. This report was conceived to evaluate the angiographic and clinical effects of calcium channel blocker therapy during the first postoperative year. PATIENTS AND RESULTS A total of 100 consecutive patients who received a radial artery graft at our institution were randomly assigned to receive (n = 53) or not receive (n = 47) calcium channel blocker therapy with oral diltiazem 120 mg/daily started in the early postoperative period. At 1-year follow-up, all patients were reassessed clinically and by Tl 201 myocardial scintigraphy, and 83 of them underwent control angiography. In 12 cases we also evaluated the response of the radial artery to the endovascular infusion of serotonin. No difference in terms of clinical outcome, scintigraphic results, and patency rate was found between patients who received or did not receive calcium channel blocker therapy. Endovascular serotonin infusion evoked an evident spastic reaction of radial artery grafts, not attenuated by calcium channel blocker therapy. CONCLUSION Calcium channel blocker therapy started immediately after surgery and continued for the first postoperative year does not affect radial artery graft patency and clinical and scintigraphic outcomes. On the basis of these data, the prophylactic use of calcium channel blocker therapy in patients with radial artery grafts seems unsubstantiated.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiac Surgery, Catholic University, Rome, Italy.
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22
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Kharabsheh S, Al-Halees Z. The radial artery as a coronary bypass conduit: dealing with hypereactivity. Ann Saudi Med 2005; 25:70-2. [PMID: 15822501 PMCID: PMC6150573 DOI: 10.5144/0256-4947.2005.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Ferguson TB. Preoperative calcium-channel blockade in cardiac surgery: the good, the bad, the issues. J Thorac Cardiovasc Surg 2004; 127:622-4. [PMID: 15001885 DOI: 10.1016/j.jtcvs.2003.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Drossos GE, Toumpoulis IK, Katritsis DG, Ioannidis JPA, Kontogiorgi P, Svarna E, Anagnostopoulos CE. Is vitamin C superior to diltiazem for radial artery vasodilation in patients awaiting coronary artery bypass grafting? J Thorac Cardiovasc Surg 2003; 125:330-5. [PMID: 12579102 DOI: 10.1067/mtc.2003.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We aimed to measure the vasodilating effects of vitamin C on the radial arteries of healthy subjects and to assess whether vitamin C is superior in this regard to diltiazem, a commonly used vasodilator in coronary artery bypass using radial conduits. METHODS In a case-control study (study 1) oral single-dose vitamin C (2 g) was given to 15 healthy nonsmokers and 15 matched otherwise healthy smokers. In a randomized double-blind study (study 2) oral single-dose vitamin C (2 g, n = 15) and diltiazem (180 mg, n = 15) were compared in preoperative patients with coronary artery disease. We examined the dilation of the radial artery with high-resolution ultrasonography and measurement of the lumen surface and color Doppler images of the nondominant radial artery just before and 2 hours after drug administration. RESULTS In study 1 both smokers and nonsmokers showed a significant increase in the lumen surface at 2 hours compared with at baseline (P <.001 and P =.013, respectively). The increase was larger in smokers (median, 37.5% vs 14.3%; P =.004). In study 2 both groups showed statistically significant increases in the lumen surface at 2 hours compared with at baseline (P <.001 and P =.008 for vitamin C and diltiazem, respectively). Vitamin C achieved a larger increase than diltiazem (median, 33.3% vs 18.2%; P =.016). In multivariate modeling the increase in lumen surface was independently predicted by use of vitamin C over diltiazem (+21.2%, P =.007), diabetes mellitus (+14.5%, P =.085), increased cholesterol (+26.2%, P =.001), and smoking history (+20.8%, P =.017). CONCLUSIONS Vitamin C is a potent acute vasodilator in both smokers and nonsmokers and is superior to diltiazem in preoperative coronary patients who need protection from vasospasm of the radial conduit.
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Affiliation(s)
- George E Drossos
- Department of Cardiothoracic Surgery, University of Ioannina School of Medicine, Ioannina, Greece
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25
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Beghi C, Nicolini F, Budillon AM, Borrello B, Ballore L, Reverberi C, Gherli T. Midterm clinical results in myocardial revascularization using the radial artery. Chest 2002; 122:2075-9. [PMID: 12475850 DOI: 10.1378/chest.122.6.2075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate the immediate and midterm results of coronary artery bypass grafting with the radial artery (RA) as a conduit. PATIENTS Two hundred forty-one patients underwent myocardial revascularization using the RA. In 78.5% of patients, three coronary vessels were involved, and in 25% of patients, the left main coronary artery was involved. The mean (+/- SD) preoperative ejection fraction was 58 +/- 13%. INTERVENTIONS The RA was implanted on branches of the circumflex artery in 81% of the cases, and the left internal mammary artery was implanted on the left anterior descending artery in 94% of patients. Total arterial myocardial revascularization was performed in 58% of patients. MEASUREMENTS AND RESULTS The in-hospital mortality rate was 0.8%. Two patients had acute myocardial infarction, and three patients experienced a transient low-cardiac output syndrome. We reviewed the records of all 171 patients who had undergone at least 6 months of follow-up after surgery. The late mortality rate in this group was 0.6% (one patient died 2 months after surgery because of cardiocirculatory arrest due to untreatable ventricular fibrillation). At a mean follow-up time of 545 +/- 253 days, two patients showed class 3 residual angina according to the Canadian Cardiovascular Society (CCS) guidelines. One patient required another hospital admission 6 months after undergoing surgery for PTCA/stenting on a circumflex artery that had not previously undergone bypass. The second patient, 8 months after undergoing coronary artery bypass grafting, underwent angiography and stenting on a stenosed anastomosis of a posterolateral branch of the circumflex artery that previously had been bypassed with the right internal mammary artery. CONCLUSIONS The routine use of the RA for coronary bypass grafting is a safe surgical technique, providing excellent clinical mid-term results in terms of cardiac event-free expectancy.
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Affiliation(s)
- Cesare Beghi
- Cardiac Surgery Department, University of Parma, Via A. Gramsci 14, 43100 Parma, Italy
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26
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Zellner JL, Spinale FG. Preventing radial artery spasm: reply. Ann Thorac Surg 2002. [DOI: 10.1016/s0003-4975(02)03431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Rosenfeldt FL, Esmore DS. Preventing radial artery spasm. Ann Thorac Surg 2002; 73:1695-6; author reply 1696. [PMID: 12022596 DOI: 10.1016/s0003-4975(02)03430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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28
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Ergul A, Joffs C, Walker AC, Spinale FG. Potential role of endothelin receptor antagonists in the setting of cardiopulmonary bypass: relevance to myocardial performance. Heart Fail Rev 2001; 6:287-94. [PMID: 11447303 DOI: 10.1023/a:1011452108131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The ET system is activated in cardiac surgical setting as evidenced by elevated systemic and myocardial ET-1 levels after coronary bypass grafting surgery which requires hypothermic cardioplegic arrest and cardiopulmonary bypass. Increased ET-1 may influence a number of clinical parameters in this setting. First, ET-1 may directly modulate myocardial contractile performance in the early postoperative period resulting in LV dysfunction and a complex postoperative course. Second, elevated ET-1 levels may exacerbate increased pulmonary vascular resistance and contribute to the development of transient pulmonary hypertension following bypass. Finally, augmented postoperative ET-1 levels could contribute to changes in the caliber and flow of vascular conduits used for coronary bypass. In this review, a current perspective on the ET system in the setting of cardiopulmonary bypass grafting surgery is provided and the potential use of ET receptor antagonists in this setting is discussed.
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Affiliation(s)
- A Ergul
- Division of Cardiothoracic Surgery, Medical University of South Carolina, USA
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Bond BR, Dorman BH, Clair MJ, Walker CA, Pinosky ML, Reeves ST, Walton S, Kratz JM, Zellner JL, Crumbley AJ, Multani MM, Spinale FG. Endothelin-1 during and after cardiopulmonary bypass: association to graft sensitivity and postoperative recovery. J Thorac Cardiovasc Surg 2001; 122:358-64. [PMID: 11479510 DOI: 10.1067/mtc.2001.114936] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our objectives are 2-fold: (1) to serially measure the release of endothelin and graft-conduit endothelin sensitivity during and after coronary artery bypass grafting and (2) to define potential relationships of changes in endothelin levels to perioperative parameters. METHODS Endothelin plasma content was measured in patients (n = 105) undergoing bypass grafting from select vascular compartments before operations and at specific intervals up to 24 hours postoperatively. Endothelin sensitivity was determined in isolated internal thoracic artery segments. RESULTS Systemic arterial and pulmonary arterial endothelin levels were increased by approximately 50% immediately after bypass grafting and increased by another 85% during the first 24 hours postoperatively. Endothelin levels were highest in patients with prolonged ventilatory requirements and extended stays in the intensive care unit (10.2 +/- 0.8 vs 13.2 +/- 1.1 fmol/mL, P =.02, and 9.8 +/- 0.7 vs 13.9 +/- 1.2 fmol/mL, P =.01, respectively. Endothelin sensitivity of the internal thoracic artery was increased in patients requiring prolonged vasodilator support with nitroglycerin. CONCLUSIONS Systemic and pulmonary arterial endothelin levels remained increased for at least 24 hours postoperatively. Prolonged pharmacologic management and increased intensive care unit stay were associated with increased systemic endothelin release and heightened graft-conduit sensitivity to endothelin.
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Affiliation(s)
- B R Bond
- Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC 29403, USA
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Kalus JS, Lober CA. Calcium-channel antagonists and nitrates in coronary artery bypass patients receiving radial artery grafts. Ann Pharmacother 2001; 35:631-5. [PMID: 11346070 DOI: 10.1345/aph.10258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the literature assessing the role of vasodilators for the prevention of vasospasm leading to graft failure in patients receiving the radial artery (RA) as a conduit in coronary artery bypass grafting (CABG). DATA SOURCE A MEDLINE search (January 1966-May 2000) was performed using calcium-channel antagonists, nitrates, radial artery, and coronary artery bypass as key words. English-language articles were identified, and the references of these articles were used to further identify pertinent articles. DATA SYNTHESIS RAs can be used as conduits in CABG. It has been suggested that failure of these grafts may be due to vasospasm, leading to occlusion observed angiographically. Calcium-channel antagonists and nitrates have been proposed as a means of preventing vasospasm and subsequent graft failure. CONCLUSIONS Currently published data on the use of calcium-channel antagonist or nitrate therapy as prophylaxis against vasospasm in patients receiving RA grafts are inconclusive. Systematic evaluations of currently available pharmacologic agents are needed to guide clinical practice in this area.
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Affiliation(s)
- J S Kalus
- College of Pharmacy, University of Toledo, OH, USA.
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31
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Abstract
We report an unusual case of vasospasm of a grafted radial artery complicated with ventricular fibrillation during the postoperative course of coronary artery bypass graft surgery. To our knowledge this is the first documented case of a radial artery graft spasm leading to a severe arrhythmia. The arrhythmia resolved spontaneously. Radial artery graft spasm was demonstrated by angiography and was successfully resolved by intravenous nitroglycerin administration.
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Affiliation(s)
- E D Gabe
- Clinical Cardiology Department, Instituto de Cardiologia y Cirugia Cardiovascular, Favaloro Foundation, Belgrano 1746 (1093), Buenos Aires, Argentina.
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