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Ann Thorac Surg 2000;69:1035-1040
© 2000 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
b Division of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA
Address reprint requests to Dr Spinale, Strom Thurmond Research Building, Medical University of South Carolina, 114 Doughty St, Suite 625, Charleston, SC 29403
Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.
Background. Radial artery (RA) is being used for coronary artery bypass grafting (CABG) with greater frequency. However, RA is prone to post-CABG vasospasm, which may be neurohormonally mediated. Use of the calcium channel antagonist diltiazem has been advocated as a strategy to reduce post-CABG RA vasospasm. However, whether and to what degree different calcium channel antagonists influence neurohormonally induced RA vasoconstriction remains unknown.
Methods. RA segments were collected from patients undergoing elective CABG (n = 13), and isometric tension was examined in the presence of endothelin (10 nM) or norepinephrine (1 µM). In matched RA, endothelin- or norepinephrine-induced contractions were measured in the presence of diltiazem (277 nM), amlodipine (73 nM), or nifedipine (145 nM). These concentrations of calcium channel antagonists were based upon clinical plasma profiles.
Results. Endothelin and norepinephrine caused a significant increase in RA-developed tension (0.54 ± 0.1 and 0.68 ± 0.1 g/mg, respectively; p < 0.05). Amlodipine or nifedipine significantly reduced RA vasoconstriction in the presence of endothelin (30 ± 6% and 41 ± 9%, respectively; p < 0.05) or norepinephrine (27 ± 8% and 53 ± 9%, respectively; p < 0.05), whereas diltiazem did not significantly reduce RA vasoconstriction.
Conclusions. These results demonstrate that neurohormonal factors released post-CABG can cause RA vasoconstriction, and that calcium channel antagonists are not equally effective in abrogating that response. Both amlodipine and nifedipine, which have a higher degree of vascular selectivity, appear to be the most effective in reducing RA vasoconstriction.
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