JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Oz M. Shapira
Gabriel S. Aldea
Richard J. Shemin
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Shapira, O. M.
Right arrow Articles by Keaney, J. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Shapira, O. M.
Right arrow Articles by Keaney, J. F., Jr

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.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
R. Ding, W. Feng, H. Li, L. Wang, D. Li, Z. Cheng, J. Guo, and D. Hu
A comparative study on in vitro and in vivo effects of topical vasodilators in human internal mammary, radial artery and great saphenous vein
Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 536 - 541.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. B. Barner
Operative Treatment of Coronary Atherosclerosis
Ann. Thorac. Surg., April 1, 2008; 85(4): 1473 - 1482.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Attaran, L. John, and A. El-Gamel
Clinical and Potential Use of Pharmacological Agents to Reduce Radial Artery Spasm in Coronary Artery Surgery
Ann. Thorac. Surg., April 1, 2008; 85(4): 1483 - 1489.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
O. M. Shapira, B. R. Eskenazi, E. Anter, L. Joseph, T. G. Christensen, C. T. Hunter, H. L. Lazar, J. A. Vita, R. J. Shemin, and J. F. Keaney Jr
Endoscopic versus conventional radial artery harvest for coronary artery bypass grafting: Functional and histologic assessment of the conduit
J. Thorac. Cardiovasc. Surg., February 1, 2006; 131(2): 388 - 394.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
O. Teskin, B. S. Uydes-Dogan, Y. Enc, F. I. Alp, D. Kaleli, S. Keser, T. Iyigun, F. Bilgen, S. Dagsali, and O. Ozdemir
Comparative Effects of Tolazoline and Nitroprusside on Human Isolated Radial Artery
Ann. Thorac. Surg., January 1, 2006; 81(1): 125 - 131.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
N. Skubas, H. B. Barner, I. Apostolidou, and D. G. Lappas
Phenylephrine to increase blood flow in the radial artery used as a coronary bypass conduit
J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 687 - 692.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. R. Sajja, G. Mannam, N. R. Pantula, and S. Sompalli
Role of Radial Artery Graft in Coronary Artery Bypass Grafting
Ann. Thorac. Surg., June 1, 2005; 79(6): 2180 - 2188.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
Y. Tabel, H. Hepaguslar, C. Erdal, H. Catalyurek, U. Acikel, Z. Elar, and O. Aslan
Diltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery
Eur. J. Cardiothorac. Surg., April 1, 2004; 25(4): 553 - 559.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
P.-G. Chassot, P. van der Linden, M. Zaugg, X. M. Mueller, and D. R. Spahn
Off-pump coronary artery bypass surgery: physiology and anaesthetic management{dagger}
Br. J. Anaesth., March 1, 2004; 92(3): 400 - 413.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
D. N. Wijeysundera, W. S. Beattie, V. Rao, and J. Karski
Calcium antagonists reduce cardiovascular complications after cardiac surgery: A meta-analysis
J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1496 - 1505.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Fazel, H. R. Mallidi, M. P. Pelletier, J. Y. Sever, G. T. Christakis, B. S. Goldman, and S. E. Fremes
Radial artery use is safe in patients with moderate to severe left ventricular dysfunction
Ann. Thorac. Surg., May 1, 2003; 75(5): 1414 - 1421.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Merlo, A. Terzi, M. Tespili, and P. Ferrazzi
Reversal of radial artery 'string sign' at 6 months follow-up
Eur. J. Cardiothorac. Surg., March 1, 2003; 23(3): 432 - 434.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
G. E. Drossos, I. K. Toumpoulis, D. G. Katritsis, J. P. A. Ioannidis, P. Kontogiorgi, E. Svarna, and C. E. Anagnostopoulos
Is vitamin C superior to diltiazem for radial artery vasodilation in patients awaiting coronary artery bypass grafting?
J. Thorac. Cardiovasc. Surg., February 1, 2003; 125(2): 330 - 335.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
W. E. Harrison, A. J. Mellor, J. Clark, and D. R. J. Singer
Vasodilator pre-treatment of human radial arteries; comparison of effects of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro
Eur. Heart J., December 1, 2001; 22(23): 2209 - 2216.
[Abstract] [PDF]

Home page
 CirculationHome page
M. Gaudino, F. Glieca, N. Luciani, F. Alessandrini, and G. Possati
Clinical and Angiographic Effects of Chronic Calcium Channel Blocker Therapy Continued Beyond First Postoperative Year in Patients With Radial Artery Grafts: Results of a Prospective Randomized Investigation
Circulation, September 18, 2001; 104(90001): I-64 - 67.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
E. D. Gabe, J. C. Figal, J. N. Wisner, and R. Laguens
Radial artery graft vasospasm
Eur. J. Cardiothorac. Surg., January 1, 2001; 19(1): 102 - 104.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. Chanda, I. Brichkov, and C. C. Canver
Prevention of radial artery graft vasospasm after coronary bypass
Ann. Thorac. Surg., December 1, 2000; 70(6): 2070 - 2074.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
O. M. Shapira, J. D. Alkon, D. S.F. Macron, J. F. Keaney Jr, J. A. Vita, G. S. Aldea, and R. J. Shemin
Nitroglycerin is preferable to diltiazem for prevention of coronary bypass conduit spasm
Ann. Thorac. Surg., September 1, 2000; 70(3): 883 - 888.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
B. R. Bond, J. L. Zellner, B. H. Dorman, M. M. Multani, J. M. Kratz, A. J. Crumbley III, F. A. Crawford Jr, and F. G. Spinale
Differential effects of calcium channel antagonists in the amelioration of radial artery vasospasm
Ann. Thorac. Surg., April 1, 2000; 69(4): 1035 - 1040.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. W. Ronan, L. A. Perry, H. B. Barner, and T. M. Sundt III
Radial artery harvest: comparison of ultrasonic dissection with standard technique
Ann. Thorac. Surg., January 1, 2000; 69(1): 113 - 114.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1999 by The American Association for Thoracic Surgery.