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Ann Thorac Surg 2007;83:132-133
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Invited commentary

Louis P. Perrault, MD, PhD, Arnaud Mommerot, MD

Department of Surgery, Montreal Heart Institute, 5000 Belanger St, Montreal, Quebec, H1T 1C8 Canada

(Email: louis.perrault{at}icm-mhi.org).

The article by Oo and colleagues [1] provides important information regarding the behavior of the radial arteries as bypass conduits when submitted to temperature changes. Clearly, a sudden fall in the temperature, caused by immersing the radial arteries in a solution kept at room temperature after harvesting, induces significant contraction mediated by a rise in intracellular calcium released from sarcoplasmic stores. This sudden effect may contribute to spasm of the graft. In contrast, gradual cooling, by keeping the graft in a warm solution that is allowed to drift slowly to room temperature, acts as a vasodilator. Nevertheless, rewarming during blood reflow increases graft tension and may cause sustained contraction. Thus the important lesson from this article is that classical stimuli (ie, trauma, stretch, diathermy) involved in the pathogenesis of the radial artery vasospasm and temperature changes must be closely controlled. From this article clinical recommendations regarding radial arterial harvesting can be drawn.

One key maneuver to prevent radial graft spasm is to keep it at a constant body temperature as long as possible by preventing exposure to the cool operating room environment. Endoscopic minimally invasive harvesting easily facilitates this, produces minimal arterial wall trauma, and limits exposure to ambient air. Moreover the graft remains in situ protected by the warm surrounding tissues until used. Another option is to keep the harvested graft in a warm solution until use, but the solution must be kept isothermic. Unfortunately subsequent rapid rewarming caused by reperfusion may have adverse effects. Topical glyceryl trinitrate seems to be the best agent to prevent both cooling-induced and rewarming-induced graft contraction as compared with calcium-channel blockers and the {alpha} adrenoreceptor antagonist, phenoxybenzamine.

This study did not take into account other contraction stimuli, such as hypoxia or endogenous prostanoids release, which can lead to radial artery contraction. Intraoperative handling is just a part of the overall efforts to prevent radial arterial contraction in patients with radial artery grafts. Indeed, spasm can also occur late after operation, and it can produce string signs, stenoses, or occlusion. Optimization of the outcomes of radial artery grafts needs to be clearly defined by long-term pharmacologic protocols documented by prospective clinical studies.


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  1. Oo AY, Conant AR, Chester MR, Dihmis WC, Simpson AWM. Temperature changes stimulate contraction in the human radial artery and affect the response to vasoconstrictors Ann Thorac Surg 2007;83:126-133.[Abstract/Free Full Text]

Related Article

Temperature Changes Stimulate Contraction in the Human Radial Artery and Affect Response to Vasoconstrictors
Aung Y. Oo, Alan R. Conant, Michael R. Chester, Walid C. Dihmis, and Alec W.M. Simpson
Ann. Thorac. Surg. 2007 83: 126-132. [Abstract] [Full Text] [PDF]




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