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Right arrow Coronary disease

Ann Thorac Surg 2006;81:120-124
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Effects of Papaverine and Glycerilnitrate-Verapamil Solution as Topical and Intraluminal Vasodilators for Internal Thoracic Artery

Francesco Formica, MD * , Orazio Ferro, MD, Matteo Brustia, MD, Fabrizio Corti, MD, Luisa Colagrande, MD, PhD, Enrica Bosisio, MD, Giovanni Paolini, MD, PhD

Cardiac Surgery Clinic, Department of Surgical Science and Intensive Care, University of Milan-Bicocca, San Gerardo Hospital, Monza (Milan), Italy

Accepted for publication June 10, 2005.

* Address correspondence to Dr Formica, Clinica Cardiochirurgia, Ospedale San Gerardo, Via Donizetti 106, Monza (Milan) 20052, Italy (Email: francesco_formica{at}fastwebnet.it).

BACKGROUND: Arterial spasm is described as an event occurring after left internal thoracic artery (LITA) harvesting. Many vasodilators have been used to treat or prevent LITA spasm. The aim of this study is to compare the effects between glyceril-trinitrate/verapamil (GV) solution and papaverine to treat LITA spasm and to determine the best delivery method.

METHODS: One hundred consecutive ischemic patients were randomly assigned to three groups: group GV (n = 34, GV solution), group P (n = 33, papaverine), or group C (n = 33, normal saline). In each patient, pedicled LITA was harvested, thereafter sprayed with the randomized solution, and covered with a sponge. Fifteen minutes after heparin administration, LITA was distally divided; flow per minute was calculated after measuring the free flow for over 15 seconds; this is named "topical free flow." Then, the vasodilator was injected intraluminally and free flow per minute was measured; this is called "intraluminal free flow."

RESULTS: Analysis of variance was applied to detect differences among groups; paired-sample t test was used for LITA topical free flow versus intraluminal free flow within single groups. Mean LITA free flows were as follows: group GV, topical free flow = 38.6 ± 25.2 mL/min versus intraluminal free flow = 58.8 ± 29 mL/min (p < 0.0001); group P, topical free flow = 45.4 ± 38.9 mL/min versus intraluminal free flow mL/min (p < 0.0001); group C, topical free flow = 31.6 ± 19.9 mL/min versus intraluminal free flow = 34 ± 19.8 mL/min (p = 0.14). Topical free flow difference among the three groups was not statistically significant (p = 0.1); intraluminal free flow difference was statistically significant (p = 0.001). Intraluminal free flow in group GV and in group P were higher than intraluminal free flow in group C (p = 0.004 and 0.001, respectively). Intraluminal free flow of group P was higher than that of group GV; this difference did not reach statistical significance (p = 1.00).

CONCLUSIONS: Glyceril-trinitrate/verapamil solution and papaverine are able to treat the spasm and increase the flow of the LITA, when they are used intraluminally. When used topically, these vasodilator agents do not ensure an optimal free flow.




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