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Ann Thorac Surg 2002;74:S1368-S1370
© 2002 The Society of Thoracic Surgeons

Supplement: Cardiothoracic Techniques and Technologies

Pretreatment with {alpha}-adrenergic blockers for prevention of radial artery spasm

C. Locker, MDa, R. Mohr, MDa*, Y. Paz, MDa, O. Lev-Ran, MDa, I. Herz, MDa, G. Uretzky, MDa, I. Shapira, MDa

a Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

* Address reprint requests to Dr Mohr, Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel.
e-mail: raphmohr{at}tasmc.health.gov.il

Presented at the Eighth Annual Cardiothoracic Techniques and Technologies Meeting 2002, Miami Beach, FL, Jan 23–26, 2002.

BACKGROUND: Radial artery (RA) conduits are prone to early vasospasm. Current intraoperative treatment with papaverine fails to inhibit postoperative RA constriction. Pretreatment with topical {alpha}-antagonist solutions can inhibit RA vasoconstriction and cause dilatation for a longer period than achieved with papaverine.

METHODS: In 10 patients undergoing myocardial revascularization, the radial artery was harvested as a skeletonized vessel. A composite graft with reverse free RA on an in situ left internal thoracic artery was prepared before construction of distal coronary anastomoses. The RA pedicle was then put in a small syringe filled with Regitine (phentolamine methansulphonic, 0.07 mg/mL) ("Jacuzzi") and warmed by immersing the container in a warm saline bath for 8 to 15 minutes. The RA free flow was measured before and after topical treatment with Regitine.

RESULTS: The mean number of grafts per patient was 2.9 (range 2 to 4). The mean number of radial anastomoses was 1.8 per patient. Left internal thoracic artery free flow was 110 ± 29 mL/min. Regitine increased radial free flow from 49 ± 35 to 77 ± 30 mL/min (p < 0.01). Five patients underwent postoperative coronary angiography. All radial anastomoses were patent.

CONCLUSIONS: Topical treatment of RA with Regitine increases RA free flow and is an effective intraoperative means of decreasing RA spasticity.




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