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J Thorac Cardiovasc Surg 1995;110:697-0703
© 1995 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Dilation of the internal mammary artery by external and intraluminal papaverine application

Bergen, Norway

Supported in part by the Karl and Louise Trollerud Foundation, the Meltzer Foundation, the Georg Store Foundation, the Norwegian Research Council for Science and the Humanities (NAVF), and The Blix’ Family Foundation for promotion of medical research.

Received for publication Oct. 12, 1994. Accepted for publication Jan. 11, 1995. Address for reprints: Einar Dregelid, MD, Department of Cardiothoracic Surgery, Surgical Clinic, Ullevål Hospital, Kirkeveien 166, 0407 Oslo, Norway.

Abstract

Three methods for prevention of perioperative spasm of the internal mammary artery were compared in 78 patients undergoing coronary artery bypass grafting. In group 1, internal mammary artery pedicles were divided distally, clamped, and placed under the upper sternum submerged in papaverine solution (1.5 mg/ml). In group 2, as in group 1 but before clamping, 2 ml of heparinized blood with 1.5 mg/ml papaverine added was injected into the vessel lumen. In group 3 treatment was as in group 2, but heparinized blood with papaverine was injected a second time just before extracorporeal bypass was begun. In a univariate analysis free flow from dilated internal mammary arteries was not significantly different among the groups (group 1, 58 ml/min; group 2, 82 ml/min; group 3, 68 ml/min; p<0.1). When free flow from dilated internal mammary arteries was the dependent variable in a regression analysis, the use of intraluminal papaverine, high blood pressure during flow measurement, and high initial blood flow were predictors of high flow (all p<0.01). Morphometric measurements on the resected distal portion of the dilated internal mammary arteries disclosed less folding of the internal elastic lamina and a larger luminal area in groups 2 and 3 compared with respective findings in group 1 (1.21 mm²and 1.42mm²versus 0.77 mm²; p<0.02). Mechanical vessel wall injury occurred in 8 of 52 internal mammary arteries treated with intraluminal papaverine. Intraluminal papaverine solution injected once or twice in addition to external papaverine exposure therefore provides a better blood flow rate and distal dilation than mere submersion in papaverine solution, but at a considerable risk of mechanical wall injury. (J THORACCARDIOVASCSURG1995;110: 697-703)

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