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J Thorac Cardiovasc Surg 2006;132:1126-1130
© 2006 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Effects of papaverine and carbon dioxide alone or in combination on the blood flow of internal thoracic artery

^a Department of Cardiovascular Surgery, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
^b Department of Pharmacology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
^c Department of Cardiovascular Surgery, Camlca Omur Hospital, Istanbul, Turkey.

Received for publication May 16, 2006; revisions received June 30, 2006; accepted for publication July 17, 2006.

^_* Address for reprints: Ismail Koramaz, MD, Karadeniz Technical University, School of Medicine, Department of Cardiovascular Surgery, TR–61187 Trabzon, Turkey (Email: ismailkoramaz{at}yahoo.com).

OBJECTIVE: The internal thoracic artery is frequently used as an arterial graft for coronary bypass. Spasms of internal thoracic artery may contribute to early myocardial ischemia. To prevent vasospasm and increase the blood flow, some vasodilatory agents (such as carbon dioxide or papaverine) are used. The aim of the study was to evaluate the combined effects of carbon dioxide and papaverine versus either alone on the blood flow of the internal thoracic artery.

METHODS: One hundred patients undergoing coronary artery bypass grafting (28 women and 72 men) with similar characteristics were randomly divided into four groups. We used the classic technique without any vasodilatory management before surgery in group 1, papaverine injection into the endothoracic fascia in group 2, and carbodissection technique in groups 3 and 4. Initial free flows of the internal thoracic arteries were measured after cutting of the vessel. After the first measurement, the ITA pedicles were washed with papaverine solution and wrapped with gauze in the first and fourth groups. Blood flow measurements were repeated 15 minutes later in all groups.

RESULTS: When vasodilatory management was applied during excision, the blood flows were significantly increased relative to group 1. The mean blood flows reached a significantly higher level in groups 1, 2, 3, and 4 at the second measurements. In groups 2 and 3, the increase at the first measurements compared to the first group's level was continuously high, but no additional increase was observed between the first and second measurements. In groups 1 and 4, regardless of whether a previous vasodilatory management was present, the increases measured at repeated measurements were significant versus each group's first measurements (P < .05).

CONCLUSIONS: Vasodilatory management, such as injection of papaverine into endothoracic fascia or carbon dioxide insufflation applied during excision, increased the free blood flows of internal thoracic artery pedicles. Exogenously applied papaverine produces an additional and continuous vasodilatation regardless of whether a vasodilatory intervention was previously applied.