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The Search of the Effects of Verapamil and Papaverin on LIMA Graft Flow in Beating Heart Coronary Bypass Surgery

Year 2010, Volume: 13 Issue: 3, 5 - 9, 01.03.2009

Abstract

The Search of the Effects of Verapamil and Papaverin on LIMA Graft Flow in Beating Heart Coronary Bypass Surgery Purpose: The most important problem encountered during the preparation phase of LIMA as being the most important graft which is used in coronary surgery and the same problem after this phase is vasospasm of LIMA. In this study, we evaluated the effects of two vasodilator drugs on LIMA flow which are used on patients in beating heart coronary artery bypass surgery. Material and Method: 40 patients were investigated who were undergone beating heart coronary artery bypass surgery. Their average age was 61.50± 11.76. The patients were divided in two groups according to applied vasodilator drugs (papaverin and verapamil groups). The existence of DM, TA and ACT values were recorded during blood flows measurement. The findings: Statistical difference was determined in male patients when compared to female patients (for verapamil p=0.037, for papaverin p=0.042) and in patients with high TA when compared to patients with low TA in the measurements done just before topical drug application and LIMA anastomoses (for verapamil, before drug application p=0.001, after drug application p=0.046, for papaverin before drug application p=0.012, after drug application p=0.021). In both groups, statistically important LIMA blood flow rises were seen after topical drug injection. However papaverin was superior to verapamil when ratio of their ability of increasing blood flow was taken into account (p=0.045). Conclusion: We concluded that short-timed warm bathing process with papaverin increased LIMA blood flow in comparison with the same process done with verapamil; besides, we saw that to keep TA high raises LIMA flow regardless of what kind of vasodilator drugs are used. We claim that, to use papaverin instead of verapamil as topical drug and to keep TA high peroperatively will be beneficial to LIMA flow just after LIMA greft was harvested in patients undergone beating heart coronary artery bypass surgery.

References

  • Ozisik K, Peker O, Demircin M. Papaverin ısısının internal mammarian arteri kan akımı üzerine etkisi. Mersin Üniversite- si Tıp Fakültesi Dergisi 2001;2:12-6.
  • Reardon MJ, Conklin LD, Reardon PR, Baldwin JC. Coro- nary artery bypass conduits: review of current status. J Car- diovasc Surg 1997;38:201-9.
  • He G-W. Arterial Grafts for Coronary Artery Bypass Graf- ting: Biological Characteristics, Functional Classification, and Clinical Choice. Ann Thorac Surg 1999;67:277-84.
  • Barner HB. Technique of myocardial revascularization. In Edmunds LH Jr, ed Cardiac Surgery in the Adult. New York: McGraw-Hill, 1997:255-94.
  • Cameron AAC, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol 1995; 25: 188-92.
  • Jones EL, Lattouf OM, Weintraub WS. Catastrophic conse- quences of internal mammary hypoperfusion. J Thorac Car- diovasc Surg 1989;98:902-7.
  • Sarabu MR, Fass A, Reed GE. Early postoperative spasm in left internal mammary bypass grafts. Ann Thorac Surg ;44:199-200. Van Son JA, Smedts F, Vincent JG, et al. Comparative ana- tomic studies of various arterial conduits for myocardial re- vascularization. J Thorac Cardiovasc Surg 1990;99:703-7.
  • Nili M, Stamler A, Sulkes J, Vidne BA. Preparation of the in- ternal thoracic artery by vasodilator drugs: is it really neces- sary? A randomized double-blind placebo-controlled clinical study. Eur J Cardiothorac Surg 1999;16:560-3.
  • Canzer CC, Dame NA. Ultrasonic assessment of internal thoracic artery graft flow in the revascularized heart. Ann Tho- rac Surg 1994;58:135-8.
  • Cooper GJ, Wilkinson GAL, Angelini GA. Overcoming pe- rioperative spasm of the internal mammary artery Which is the best vasodilator? J Thorac Cardiovasc Surg 1992;104:465-8.
  • Jett GK, Guyton RA, Hatcher CR Jr, Abel PW. Inhibition of human internal mammary artery contractions. An in vitro study of vasodilators. J Thorac Cardiovasc Surg 1992; 104: 977-82.
  • Yavuz S, Celkan A, Göncü T, et al. Effect of papaverine applications on blood flow of the internal mammary ar- tery.Ann Thorac Cardiovasc Surg 2001;7:84-8.
  • Tabel Y, Hepağufllar H, Erdal C, et al. Diltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery. Eur J Cardiothorac Surg 2004;25:553-9.
  • Shapira OM, Alkon JD, Macron DS, et al. Nitroglycerin is preferable to diltiazem for prevention of coronary bypass con- duit spasm. Ann Thorac Surg 2000;70:883-8; discussion 888-9.
  • Izzat MB, West RR, Ragoonanan C, Angelini GD. Effect of systemic vasodilators on internal mammary artery flow Impli- cations for postoperative treatment after myocardial revascu- larization. J Thorac Cardiovasc Surg 1994;108:82-5.
  • Singh RN, Sosa JA. Internal mammary artery: a “live” con- duit for coronary bypass. J Thorac Cardiovasc Surg 1984; 87: 8.
  • Hillier C, Watt PA, Spyt TJ, Thurston H. Contraction and re- laxation of human internal mammary artery after intraluminal ad- ministration of papaverine. Ann Thorac Surg 1992; 53: 1033-7.
  • He GW, Buxton BF, Rosenfeldt FL, et al. Pharmacologic dilatation of the internal mammary artery during coronary bypass grafting. J Thorac Cardiovasc Surg 1994; 107: 1440-7.
  • Sasson L,Cohen AJ, Hauptman E,Schachner. Effect of to- pical vasodilators on internal mammary arteries. Ann Thorac Surg 1995; 59: 494-6.
  • Cameron AAC, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical followup. J Am Coll Car- diol 1995;25:188-92.
  • Mills NL, Bringaze WL III. Preparation of the internal mam- mary artery graft Which is the best method? J Thorac Cardio- vasc Surg 1989; 98: 73-9.
  • Dregelid E, Heldal K, Resch F, et al.Dilation of the internal mammary artery by external and intraluminal papaverine app- lication. J Thorac Cardiovasc Surg 1995; 110: 697-703.
  • Dregelid E, Herdal K, Andersen KS, et al. Dilatation of the internal mammary artery by external papaverine application to the pediclean improved method. Eur J Cardiothoracic Surg ;7:158-63. Tanaka KA, Szlam F, Katori N, et al. A in vitro effects of an- tihypertensive drugs on thromboxane agonist (U46619)-indu- ced vasoconstriction in human internal mammary artery. Br J Anaesth 2004;93:257-62.
  • Luscher TF, Diederich D, Siebenmann R, et al. Difference between endothelium-dependent relaxation in arterial and in ve- nous coronary bypass grafts. N Eng J Med 1988; 319: 462-7.

Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi

Year 2010, Volume: 13 Issue: 3, 5 - 9, 01.03.2009

Abstract

Amaç: Koroner arter cerrahisinde kullan›lan en önemli greft olan sol internal mamariyan arter (L‹MA)'n›n haz›rlanmas› nda ve sonras›nda karfl›lafl›lan en önemli sorun L‹MA spazm›d›r. Bu çal›flmada, atan kalpte koroner baypas (OPCAB) hastalar›nda kulland›¤›m›z iki vazodilatör ajan›n L‹MA ak›m› üzerine olan etkilerini de¤erlendirdik. Materyal ve Metod: OPCAB yap›lan 40 hasta çal›flmaya al›nd›. Hastalar›n yafl ortalamas› 61.50 ± 11.76 y›l idi. Hastalar uygulanan vazodilatör ajana göre iki gruba ayr›ld› (papaverin ve verapamil gruplar›). Kan ak›m ölçümleri esnas› nda diyabetes mellitus (DM) varl›¤›, tansiyon arteriyel (TA) ve aktive edilmifl p›ht›laflma zaman› (ACT) de¤erleri ölçülerek kaydedildi. Bulgular: Topikal ilaç uygulamas›ndan önce ve L‹MA anastomoz edilmeden hemen önce yap›lan ölçümlerde gruplar aras›nda erkek hastalarda kad›n hastalara göre (verapamil için p=0.037, papaverin için p=0.042) ve TA yüksek olan hastalarda TA de¤eri düflük olan hastalara göre (verapamil için ilaç uygulama öncesi p=0.001, ilaç uygulama sonras› p=0.046, papaverin için ilaç uygulama öncesi p=0.012, ilaç uygulama sonras› p=0.021) istatistiksel olarak anlaml› farkl›l›k gözlendi (p

References

  • Ozisik K, Peker O, Demircin M. Papaverin ısısının internal mammarian arteri kan akımı üzerine etkisi. Mersin Üniversite- si Tıp Fakültesi Dergisi 2001;2:12-6.
  • Reardon MJ, Conklin LD, Reardon PR, Baldwin JC. Coro- nary artery bypass conduits: review of current status. J Car- diovasc Surg 1997;38:201-9.
  • He G-W. Arterial Grafts for Coronary Artery Bypass Graf- ting: Biological Characteristics, Functional Classification, and Clinical Choice. Ann Thorac Surg 1999;67:277-84.
  • Barner HB. Technique of myocardial revascularization. In Edmunds LH Jr, ed Cardiac Surgery in the Adult. New York: McGraw-Hill, 1997:255-94.
  • Cameron AAC, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical follow-up. J Am Coll Cardiol 1995; 25: 188-92.
  • Jones EL, Lattouf OM, Weintraub WS. Catastrophic conse- quences of internal mammary hypoperfusion. J Thorac Car- diovasc Surg 1989;98:902-7.
  • Sarabu MR, Fass A, Reed GE. Early postoperative spasm in left internal mammary bypass grafts. Ann Thorac Surg ;44:199-200. Van Son JA, Smedts F, Vincent JG, et al. Comparative ana- tomic studies of various arterial conduits for myocardial re- vascularization. J Thorac Cardiovasc Surg 1990;99:703-7.
  • Nili M, Stamler A, Sulkes J, Vidne BA. Preparation of the in- ternal thoracic artery by vasodilator drugs: is it really neces- sary? A randomized double-blind placebo-controlled clinical study. Eur J Cardiothorac Surg 1999;16:560-3.
  • Canzer CC, Dame NA. Ultrasonic assessment of internal thoracic artery graft flow in the revascularized heart. Ann Tho- rac Surg 1994;58:135-8.
  • Cooper GJ, Wilkinson GAL, Angelini GA. Overcoming pe- rioperative spasm of the internal mammary artery Which is the best vasodilator? J Thorac Cardiovasc Surg 1992;104:465-8.
  • Jett GK, Guyton RA, Hatcher CR Jr, Abel PW. Inhibition of human internal mammary artery contractions. An in vitro study of vasodilators. J Thorac Cardiovasc Surg 1992; 104: 977-82.
  • Yavuz S, Celkan A, Göncü T, et al. Effect of papaverine applications on blood flow of the internal mammary ar- tery.Ann Thorac Cardiovasc Surg 2001;7:84-8.
  • Tabel Y, Hepağufllar H, Erdal C, et al. Diltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery. Eur J Cardiothorac Surg 2004;25:553-9.
  • Shapira OM, Alkon JD, Macron DS, et al. Nitroglycerin is preferable to diltiazem for prevention of coronary bypass con- duit spasm. Ann Thorac Surg 2000;70:883-8; discussion 888-9.
  • Izzat MB, West RR, Ragoonanan C, Angelini GD. Effect of systemic vasodilators on internal mammary artery flow Impli- cations for postoperative treatment after myocardial revascu- larization. J Thorac Cardiovasc Surg 1994;108:82-5.
  • Singh RN, Sosa JA. Internal mammary artery: a “live” con- duit for coronary bypass. J Thorac Cardiovasc Surg 1984; 87: 8.
  • Hillier C, Watt PA, Spyt TJ, Thurston H. Contraction and re- laxation of human internal mammary artery after intraluminal ad- ministration of papaverine. Ann Thorac Surg 1992; 53: 1033-7.
  • He GW, Buxton BF, Rosenfeldt FL, et al. Pharmacologic dilatation of the internal mammary artery during coronary bypass grafting. J Thorac Cardiovasc Surg 1994; 107: 1440-7.
  • Sasson L,Cohen AJ, Hauptman E,Schachner. Effect of to- pical vasodilators on internal mammary arteries. Ann Thorac Surg 1995; 59: 494-6.
  • Cameron AAC, Green GE, Brogno DA, Thornton J. Internal thoracic artery grafts: 20-year clinical followup. J Am Coll Car- diol 1995;25:188-92.
  • Mills NL, Bringaze WL III. Preparation of the internal mam- mary artery graft Which is the best method? J Thorac Cardio- vasc Surg 1989; 98: 73-9.
  • Dregelid E, Heldal K, Resch F, et al.Dilation of the internal mammary artery by external and intraluminal papaverine app- lication. J Thorac Cardiovasc Surg 1995; 110: 697-703.
  • Dregelid E, Herdal K, Andersen KS, et al. Dilatation of the internal mammary artery by external papaverine application to the pediclean improved method. Eur J Cardiothoracic Surg ;7:158-63. Tanaka KA, Szlam F, Katori N, et al. A in vitro effects of an- tihypertensive drugs on thromboxane agonist (U46619)-indu- ced vasoconstriction in human internal mammary artery. Br J Anaesth 2004;93:257-62.
  • Luscher TF, Diederich D, Siebenmann R, et al. Difference between endothelium-dependent relaxation in arterial and in ve- nous coronary bypass grafts. N Eng J Med 1988; 319: 462-7.
There are 24 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

İbrahim Sami Karacan This is me

Ömer Ulular This is me

Kanat Özışık This is me

U¤ursay K›z›ltepe This is me

Publication Date March 1, 2009
Published in Issue Year 2010 Volume: 13 Issue: 3

Cite

APA Karacan, İ. S. ., Ulular, Ö. ., Özışık, K. ., K›z›ltepe, U. . (2009). Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi. Koşuyolu Kalp Dergisi, 13(3), 5-9. https://doi.org/10.17557/tjfc.90307
AMA Karacan İS, Ulular Ö, Özışık K, K›z›ltepe U. Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi. Koşuyolu Kalp Dergisi. March 2009;13(3):5-9. doi:10.17557/tjfc.90307
Chicago Karacan, İbrahim Sami, Ömer Ulular, Kanat Özışık, and U¤ursay K›z›ltepe. “Atan Kalpte Koroner Baypas Cerrahisinde Papaverin Ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi”. Koşuyolu Kalp Dergisi 13, no. 3 (March 2009): 5-9. https://doi.org/10.17557/tjfc.90307.
EndNote Karacan İS, Ulular Ö, Özışık K, K›z›ltepe U (March 1, 2009) Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi. Koşuyolu Kalp Dergisi 13 3 5–9.
IEEE İ. S. . Karacan, Ö. . Ulular, K. . Özışık, and U. . K›z›ltepe, “Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi”, Koşuyolu Kalp Dergisi, vol. 13, no. 3, pp. 5–9, 2009, doi: 10.17557/tjfc.90307.
ISNAD Karacan, İbrahim Sami et al. “Atan Kalpte Koroner Baypas Cerrahisinde Papaverin Ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi”. Koşuyolu Kalp Dergisi 13/3 (March 2009), 5-9. https://doi.org/10.17557/tjfc.90307.
JAMA Karacan İS, Ulular Ö, Özışık K, K›z›ltepe U. Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi. Koşuyolu Kalp Dergisi. 2009;13:5–9.
MLA Karacan, İbrahim Sami et al. “Atan Kalpte Koroner Baypas Cerrahisinde Papaverin Ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi”. Koşuyolu Kalp Dergisi, vol. 13, no. 3, 2009, pp. 5-9, doi:10.17557/tjfc.90307.
Vancouver Karacan İS, Ulular Ö, Özışık K, K›z›ltepe U. Atan Kalpte Koroner Baypas Cerrahisinde Papaverin ve Verapamilin L‹MA Grefti Ak›m› Üzerine Olan Etkilerinin ‹ncelenmesi. Koşuyolu Kalp Dergisi. 2009;13(3):5-9.