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Ann Thorac Surg 2008;86:350-351. doi:10.1016/j.athoracsur.2007.12.076
© 2008 The Society of Thoracic Surgeons
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Correspondence

Treatment With Phenoxybenzamine May Lead to Loss of Endothelial Viability in Radial Artery

Remananda Krishnanand Pai, FRCSa, Alan R. Conant, PhDb, Walid C. Dihmis, FRCS(CTh)b

a Cardiac Surgery, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, B15 2TH United Kingdom
b The Cardiothoracic Centre, Liverpool NHS Trust, The Research Laboratories, Thomas Dr, Liverpool, L14 3PE United Kingdom

(Email: kardiac_pai{at}rediffmail.com; conant{at}liv.ac.uk).

To the Editor:

We read with interest the article by Kulik and colleagues [1] describing supporting evidence for the use of phenoxybenzamine as a topical treatment for radial artery grafts. The original demonstration of phenoxybenzamine's use by Taggart's group in 2000 [2], employed a similar dose to Kulik and colleagues (2 mg/mL) [1]. However, later studies, including those of Taggart's group, demonstrated a complete inhibition of catecholamine-induced vasoconstriction at lower doses [3–5].

Previous studies measured endothelium-mediated vasodilatation immediately after treatment. We were interested in the effects on endothelial viability, which may be slow to develop. Endothelial cells were cultured from sections of radial artery (n=5), obtained excess to surgery with informed patient consent and ethical committee approval. Cells were treated with phenoxybenzamine for 30 minutes and viability assessed immediately or after 24 hours recovery, using a resazurin-based viability assay [6]. Table 1 demonstrates that the true extent of damage is only apparent with time and is significant only at higher doses.


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  		Table 1 Effects of phenoxybenzamine treatment on endothelial viability.
 
We would conclude that lower doses of phenoxybenzamine would benefit endothelial viability and potentially the long-term patency of the graft.


   References
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 References
 

  1. Kulik A, Rubens FD, Gunning D, et al. Radial artery graft treatment with phenoxybenzamine is clinically safe and may reduce perioperative myocardial injury Ann Thorac Surg 2007;83:502-509.[Abstract/Free Full Text]
  2. Taggart DP, Dipp M, Mussa S, Nye PCG. Phenoxybenzamine prevents spasm in radial artery conduits for coronary artery bypass grafting J Thorac Cardiovasc Surg 2000;120:815-817.[Free Full Text]
  3. Corvera JS, Morris CD, Budde JM, et al. Pretreatment with phenoxybenzamine attenuates the radial artery's vasoconstrictor response to alpha-adrenergic stimuli J Thorac Cardiovasc Surg 2003;126:1549-1554.[Abstract/Free Full Text]
  4. Harrison WE, Mellor AJ, Clark J, Singer DRJ. Vasodilator pre-treatment of human radial arteries: comparison of effects of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro Eur Heart J 2001;22:2209-2216.[Abstract/Free Full Text]
  5. Mussa S, Guzik TJ, Black E, Dipp MA, Channon KM, Taggart DP. Comparative efficacies and durations of action of phenoxybenzamine, verapamil/nitroglycerin solution, and papaverine as topical antispasmodics for radial artery coronary bypass grafting J Thorac Cardiovasc Surg 2003;126:1798-1805.[Abstract/Free Full Text]
  6. O'Brien J, Wilson I, Orton T, Pognan F. Investigation of the Alamar Blue (resazurin) fluorescent dye for the assessment of mammalian cell cytotoxicity Eur J Biochem 2000;267:5421-5426.[Medline]

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Reply
Alexander Kulik, Fraser D. Rubens, and Marc Ruel
Ann. Thorac. Surg. 2008 86: 351-352. [Extract] [Full Text] [PDF]



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A. Kulik, F. D. Rubens, and M. Ruel
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Ann. Thorac. Surg., July 1, 2008; 86(1): 351 - 352.
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