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J Thorac Cardiovasc Surg 1999;117:906-911
© 1999 Mosby, Inc.

SURGERY FOR ADULT CARDIOVASCULAR DISEASE

NITROGLYCERIN IS SUPERIOR TO DILTIAZEM AS A CORONARY BYPASS CONDUIT VASODILATOR

Oz M. Shapira, MDa, Aiming Xu, PhDb, Joseph A. Vita, MDb, Gabriel S. Aldea, MDa, Nirav Shah, MDb, Richard J. Shemin, MDa, John F. Keaney, Jr, MDb

From the Department of Cardiothoracic Surgerya and Evans Department of Medicine,b Boston University School of Medicine, Boston, Mass.

This work was supported by grants from the American Heart Association, National Center (J.F.K), and the National Institute of Health (HL53398 and HL55993 to J.A.V. and HL59346 to J.F.K). J.A.V. is an Established Investigator of the American Heart Association, and J.F.K. is the recipient of a Clinical Investigator Development Award (HL03195) from the National Institutes of Health.

Received for publication July 28, 1998. Revisions requested Nov 5, 1998. Revisions received Jan 11, 1999. Accepted for publication Jan 12, 1999. Address for reprints: Oz M. Shapira, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 E Newton St, Boston, MA 02118.

Background: Recent reports of improved radial artery patency have been attributed, in part, to routine use of diltiazem to prevent vasospasm. However, diltiazem is costly, and its use may be associated with negative inotropic and chronotropic side effects. This study compares the vasodilatory properties of diltiazem to those of nitroglycerin.
Methods: In vitro, with the use of organ chambers, the vasodilatory properties of diltiazem and nitroglycerin were compared in matched segments of radial artery, internal thoracic artery, and saphenous vein that were harvested from the same patients (n = 11). The vasodilatory response of the radial artery to intravenous diltiazem or nitroglycerin was compared in vivo (n = 10) with the use of ultrasonographic measurements of radial artery diameter.
Results: The maximum relaxation of radial artery (100% ± 4%), internal thoracic artery (96% ± 4%), and saphenous vein (100% ± 3%) to nitroglycerin were significantly greater than the response to diltiazem (33% ± 6%, 22% ± 7%, and 34% ± 5%, respectively; P < .001). The thromboxane mimetic, U46619, induced radial artery spasm with a median effective concentration of 3.7 ± 0.8 nmol/L. Physiologic concentrations of nitroglycerin (0.1 µmol/L) significantly inhibited the radial artery response to U46619 (median effective concentration, 6.2 ± 1.1 nmol/L; P = .046), whereas diltiazem (1 µmol/L) did not (median effective concentration, 3.7 ± 0.8 nmol/L; P = .64). In vivo, nitroglycerin increased radial artery diameter 22% ± 3%, which was significantly greater than diltiazem (3% ± 0.5%; P = .001).
Conclusion: Nitroglycerin is a superior conduit vasodilator and is more effective in preventing graft spasm than diltiazem. Nitroglycerin should be strongly considered as the drug of choice to prevent conduit spasm after coronary bypass grafting.




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