Papaverine Delivery to the Internal Mammary Artery Pedicle Effectively Treats Spasm

Girard, Dhru S.; Sutton, Jonathan; Williams, Timothy H.; Crumbley, Arthur J.; Zellner, James L.; Kratz, John M.; Crawford, Fred A.

doi:10.1016/j.athoracsur.2004.01.061

Cited by 29 publications

(39 citation statements)

References 18 publications

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“…Dilatation of the artery and its branches by papaverine helps visualization and allows easy division. On the other hand, Girard and colleagues 6 reported that endothoracic papaverine application was no better than alternative applications in increasing ITA fl ow, and did not reduce the harvesting time. In our study, the fi rst fl ow measurement was higher in the group that received papaverine into the endothoracic space.…”

Section: Discussionmentioning

confidence: 98%

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Endothoracic Papaverine Application for Internal Thoracic Artery Harvest

Bahçivan

Kolbakir

Karamustafa

et al. 2007

Asian Cardiovasc Thorac Ann

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This study compared the effects of different methods of papaverine application on free blood flow and harvesting time of the internal thoracic artery for coronary bypass grafting. Patients were randomly divided into 3 groups of 25 each: group 1 had papaverine injected into the endothoracic tissue around the internal thoracic artery before dissection, group 2 had papaverine injected into the periarterial tissues of the internal thoracic artery pedicle, and group 3 had intraluminal papaverine applied retrogradely into the internal thoracic artery. Mean blood flow was 56.3 +/- 21.3, 21.1 +/- 13.2, and 20.9 +/- 9.1 mL x min(-1) in groups 1, 2, and 3, respectively, immediately after harvesting. Flow in group 1 was significantly better than that in groups 2 and 3. Immediately before anastomosis, mean flow was 89.8 +/- 19.1, 97.6 +/- 35.4, and 95.9 +/- 19.9 mL x min(-1) in groups 1, 2, and 3, respectively, with no significant difference among groups. Internal thoracic artery harvesting times were shorter in group 1 than in groups 2 and 3. Administering papaverine into the endothoracic fascia of the internal thoracic artery bed prior to dissection is a reliable method that facilitates rapid harvesting of the graft without causing trauma and consequent spasm.

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Section: Discussionmentioning

confidence: 98%

“…It has been suggested that this might reduce the risk of ITA damage and shorten the duration of harvesting. 5,6 The aim of this study was to compare the effects of different methods of papaverine application on the harvesting time and free blood fl ow in ITA prepared for CABG.…”

Section: Introductionmentioning

confidence: 99%

Endothoracic Papaverine Application for Internal Thoracic Artery Harvest

Bahçivan

Kolbakir

Karamustafa

et al. 2007

Asian Cardiovasc Thorac Ann

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“…[37] In another study, it is reported that if low flow in ITA was detected during the operation, this graft tends to occlussion in in long period. [38] As well, like other arterial grafts, any agent, which causes vasospasm on ITA, causes significantly decrease in graft flow. [39] This condition may induce perioperative morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Effects Of Dopamine On Internal Thoracic Artery Graft Which Is Used In Coronary Artery Bypasses

Halıcı¹,

Ege²,

Karadağ³

et al. 2009

TUTFD

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© Trakya Üniversitesi T p Fakültesi Dergisi. AVES Yay nc l k taraf ndan bas lm t r. Her hakk sakl d r. © Medical Journal of Trakya University. Published by AVES Publishing. All rights reserved. In Vitro Effects of Dopamine on Internal Thoracic Artery Graft Used inM-10 -7 M produced a mild relaxant effect on phenylephrine-precontracted ITA, and at higher concentrations than 10 -7 M it produced a constrictor response. Ther relaxant effect of dopamine was partially antagonized by L-NAME (nitric oxide synthase inhibitor, 10 -6 M), propranolol (10 -6 M), and cis--flupenthixol (dopaminergic receptor antagonist, 10 -6 M), but not by metoclopramide (D 2 -dopaminergic receptor antagonist). The constrictor effect of dopamine was partially antagonized by phentolamine, prazosin and, yohimbine. Conclusion:It was concluded that, while dopamine produces a vasodilator response at the lower concentrations, it causes a constrictor effect on ITA at the higher concentrations. Both a -adrenergic and a nitric oxide mediated mechanism (via D 1 -dopaminergic receptor) may play a role in the relaxant effect of dopamine on ITA at the lower concentrations. Constrictor response to dopamine at the higher concentrations on ITA may be produced by the activation of 1 -and 2 -adrenergic receptors.Key words: Internal thoracic artery; coronary artery bypass surgery; dopamine. Amaç:Bu çal man n amac dopaminin internal torasik arter ( TA) grefti üzerine etkilerini, invitro ara t rmakt r. Gereç ve Yöntemler: Aral k 2003-Haziran 2005 tarihleri aras nda klini imizde koroner arter bypass greft (CABG)operasyonu olan toplam 32 hasta (2'si kad n 30'u erkek, ortalama ya ; 59.256±8,.34, 37-75 ya lar aras ) çal maya al nd . n vitro organ banyosunda hastalar n ITA'lar ndan arta kalan parçac klar üzerinde dopaminin olu turdu u kas c ve gev etici yan tlar isometrik olarak kaydedildi. Bulgular: Dopamin 10-9 M-10 -7 M konsantrasyon aral nda fenilefrinle önceden kast r lm ITA'da hafif bir gev eme yan t , sonras nda artan konsantrasyonlar nda (>10 -7 M) kas lma yan t gerçekle tirdi i gözlendi. Dopaminin gev etici etkisinin k smen L-NAME (nitrik oksit sentaz inhibitorü, 10 -6 M), propranolol (10 -6 M) ve cis--flupentiksol (dopaminerjik reseptör antagonisti, 10 -6 M) ile k smen azald fakat metoklopramidin (D 2 -dopaminerjik reseptör antagonisti) dopaminin kaynakl gev emeye etki yapmad gözlendi. Dopaminin ITA'daki kas c etkisi k smen fentolamin, prazosin ve yohimbin ile antagonize edildi i gözlendi.Sonuç: Sonuç olarak dopamin dü ük konsantrasyonlarda ITA'da vazodilatasyon yan t n olu tururken daha yüksek konsantrasyonlarda ITA'da vasokonstriksiyon yan t n olu turmaktad r. -adrenerjik ve nitrik oksit arac l mekanizma (D 1 -dopaminerjik reseptör yoluyla) dopaminin dü ük konsantrasyonlar nda ITA'da olu turdu u gev etici etkide rol alabilir. Dopaminin yüksek konsantrasyonlardaki ITA'da olu turdu u kas c etki 1 -ve 2 -adrenerjik reseptörlerin aktivasyonu ile olu turulmaktad r.Anahtar sözcükler: nternal torasik arter; koroner arter bypass cerrahisi; dopamin Trakya Univ Tip ...

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“…However, IMA spasm can occur during dissection of the artery, and surgical stimulus is well recognized as one of the important factors of vasoconstrictor activity 3,4 . Spasm decreases graft flow, which can impact morbidity and mortality 2,5 . Various methods are used to prevent vasospasm and increase the blood flow such as papaverine injection or carbondioxide insufflation through the endothoracic fascia, parallel to the mammary artery before harvesting.…”

mentioning

confidence: 99%

“…Various methods are used to prevent vasospasm and increase the blood flow such as papaverine injection or carbondioxide insufflation through the endothoracic fascia, parallel to the mammary artery before harvesting. This method may inhibit spasm and the additional hydrodissection may make harvest quicker and easier 5,6 . In our department, we routinely use papaverine but occasionally insufflate the room air by the injector into the endothoracic fascia to minimize surgical trauma and make quick dissection before LIMA harvest.…”

mentioning

confidence: 99%