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J Thorac Cardiovasc Surg 1998;115:1321-1325
© 1998 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Supported by the Hong Kong Research Grants Council (grant 338/048/0004). Partially supported by Committee of Research and Conference Grant (337/048/0018, 335/048/0079) and University Grant (014/048/9602 and 344/048/0001), The University of Hong Kong.
Received for publication June 19, 1997. Revisions requested July 30, 1997; revisions received Jan. 19, 1998. Accepted for publication Jan. 21, 1998. Address for reprints: Professor Guo-Wei He, MD, PhD, Chair of Cardiothoracic Surgery, University of Hong Kong, Grantham Hospital, 125 Wong Chuk Hang Rd., Aberdeen, Hong Kong.
Abstract
Background: Endothelium plays a key role in graft patency. My colleagues and I have developed a verapamil+nitroglycerin solution (balanced to pH 7.4) to prepare the radial artery without mechanical distention or dilation and have reported the efficacy of its antispastic action. This study was designed to investigate whether using this solution as part of the University of Hong Kong protocol to prepare the radial artery is more efficacious than papaverine solution in preserving endothelial function.
Methods: Ring segments of the radial artery taken from 25 patients undergoing coronary artery bypass grafting were studied in organ chambers. The endothelium-dependent relaxation, as the index of endothelial function, was examined by two mechanisms—receptor-mediated relaxation (by acetylcholine) and non–receptor-mediated relaxation (by calcium ionophore A23187) in U46619-induced contraction (10 nmol/L).
Results: In the relaxation induced by either acetylcholine (27.3% ± 5.0% [n = 7] vs 23.9% ± 3.9% [n = 6], p = 0.6) or A23187 (62.9% ± 6.0% [n = 13] vs 62.3% ± 8.4% [n = 6], p = 0.96), there was no significant difference between the control radial arteries and those treated with the verapamil+nitroglycerin solution. In the papaverine-treated rings, acetylcholine-mediated relaxation was abolished (3.3% ± 2.6% vs 23.9% ± 3.9%, p < 0.001) and A23187-mediated relaxation was significantly reduced (39.7% ± 5.2% vs 62.3% ± 8.4%, p = 0.02) compared with verapamil+nitroglycerin treatment.
Conclusion: Use of verapamil+nitroglycerin solution to prepare the radial artery maximally preserves endothelial function. In contrast, papaverine impairs this function. Verapamil+nitroglycerin solution may be effectively and safely used to prepare the radial artery for coronary artery bypass grafting.
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