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J Thorac Cardiovasc Surg 2004;128:354-356
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Effect of carbon dioxide insufflation on free internal thoracic artery flows: Is it a vasodilator?

Mehmet Özkan, MD^*,a, smail Koramaz, MD^b, A. Tulga Ulus, MD^c, Yusuf Tavil, MD^a, Hakan Filizlioglu, MD^a, Emre C. Baykan, MD^a, Sadk Erylmaz, MD^d, Bahadr Inan, MD^d, S. Fehmi Katrcoglu, MD^c, Ümit Özyurda, MD^d

^a Department of Cardiovascular Surgery, Ozel Karadeniz Hospital, Trabzon, Turkey
^b Department of Cardiovascular Surgery, Karadeniz Technical University, Trabzon, Turkey
^c Department of Cardiovascular Surgery, Turkiye Yüksek htisas Hospital, Ankara, Turkey
^d Department of Cardiovascular Surgery, University of Ankara, Ankara, Turkey

Received for publication June 24, 2003; revisions received October 10, 2003; revisions received November 5, 2003; accepted for publication November 12, 2003.

^* Address for reprints: Mehmet Özkan, MD, Karadeniz Hastanesi, Yavuz Selim Blv No. 110, Trabzon 61040, Turkey
mehmetozk{at}hotmail.com

BACKGROUND: This study was conceived to evaluate the effect of carbon dioxide insufflation on free internal thoracic artery flows.

METHODS: We studied 56 consecutive patients who underwent coronary artery bypass grafting in which the left internal thoracic artery was anastomosed to the left anterior descending artery. The first 26 consecutive internal thoracic arteries were harvested as a pedicled graft (group 1), and the next 30 consecutive internal thoracic arteries were dissected by using the carbon dioxide insufflation technique (group 2). The internal thoracic artery harvesting was performed by 2 experienced surgeons by using the same instrumentation and technique. First, free flows of the internal thoracic arteries were registered after distal cutting of the vessel in both groups. After the first measurements, diluted papaverine was sprayed on the internal thoracic artery pedicle only in group 1, and then second measurements were registered after 15 minutes in both groups. Hemodynamic parameters were recorded with each measurement.

RESULTS: The first free flow measurement was significantly higher in the carbon dioxide–insufflated internal thoracic arteries (group 2, 60 ± 32 mL/min; group 1, 28 ± 19 mL/min; P < .05). Although the second free flow measurement of the carbon dioxide–insufflated group was higher than in group 1, the difference was not statistically significant (68 ± 46 mL/min vs 53 ± 32 mL/min; P = .53).

CONCLUSIONS: Carbon dioxide insufflation of the internal thoracic artery is an efficient technique to increase the flow and seems to be safe, simple, and reliable. When the internal thoracic artery is harvested in a carbon dioxide–insufflated fashion, arterial spasm and reduced early flow may be avoided, even without vasodilator agents such as papaverine.

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				M. Ozkan Reply to the Editor J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1204 - 1204. [Full Text] [PDF]