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Ann Thorac Surg 2002;74:695-699
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Acute effects of 17ß-estradiol on left internal mammary graft after coronary artery bypass grafting

^a Department of Cardiac Surgery, University of Milan, Centro Cardiologico Monzino, Milan, Italy
^b Department of Cardiac Anesthesia, University of Milan, Centro Cardiologico Monzino, Milan, Italy

Accepted for publication April 30, 2002.

* Address reprint requests to Dr Polvani, Department of Cardiac Surgery, University of Milan, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy
e-mail: luca.polvani{at}cardiologicomonzino.it

Background. Vasospasm of arterial conduits used for coronary surgical procedures is an important cause of postoperative graft failure. Mounting experimental evidence suggests that estrogen reverses acetylcholine-induced vasospasm of the coronary arteries in animals and humans. Estrogen also affects endothelium-derived constrictor factors. We therefore investigated the in vivo vasomotor responses to transdermal 17ß-estradiol of the left internal mammary artery (LIMA) grafted on the anterior descending coronary artery.

Methods. We studied 20 women, mean age of 62 ± 7.2 years (range, 48 to 73 years), who had undergone cardiopulmonary bypass for coronary artery bypass grafting. They received transdermal 17ß-estradiol on the fifth day after operation. The diameter, cross-sectional area, and blood flow of the LIMA graft were measured by transthoracic color Doppler echography before (basal values) and after the transdermal administration of 50 µg of 17ß-estradiol (control).

Results. LIMA graft vasodilation after the administration of 17ß-estradiol was observed. A significant increase in diameter (2.06 ± 0.4 mm versus 2.37 ± 0.28 mm; p = 0.035) and cross-sectional area (3.45 ± 1. 2 mm² versus 4.24 ± 1 mm²; p = 0.039) was registered. The LIMA graft mean flow increased by 49% (44.76 ± 27.19 mL/min versus 56.62 ± 27.69 mL/min), but this increase was not statistically significant (p = 0.06).

Conclusions. The acute postoperative transdermal administration of 17ß-estradiol induced a significant increase of LIMA graft diameter and cross-sectional area in postmenopausal women who underwent coronary artery bypass grafting. The LIMA graft vasodilation was also associated with an improvement in LIMA blood flow.

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