Comparison of direct effects of clinically available vasodilators; nitroglycerin, nifedipine, cilnidipine and diltiazem, on human skeletonized internal mammary harvested with ultrasonic scalpel

Fukuda, Shoji; Nakamura, Yuji; Egi, Koso; Fujioka, Shunichiro; Nagasaka, Satoshi; Minh, Pham Ngoc; Toguchi, Koji; Wada, Takeshi; Izumi-Nakaseko, Hiroko; Ando, Kentaro; Mizoue, Tetsuya; Takazawa, Kenji; Hosaka, Shigeru; Sugiyama, Atsushi

doi:10.1007/s00380-016-0797-y

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…An earlier RCT by Guadino et al suggested that long-term postoperative CCB was not associated with better RA graft patency and may not provide outcome bene ts for patients who had RA grafts 29,32 , although their recent study with questionable methodology argued against their previous conclusion: the post hoc analysis of data pooled from six RCTs comparing RA and SVG showed that chronic postoperative CCB therapy may improve RA graft patency and reduce the incidence of major cardiovascular events 33 . Numbers of in vitro and in vivo studies of RA sections or conduits indicated that nitroglycerin was more effective than diltiazem in preventing the contraction of RA grafts 30,34 ; compared to other CCBs, diltiazem was less effective in preventing graft contraction caused by endothelin-1 and norepinephrine, which affected RA more than LITA 28 . Chanda et al proposed that the combination of nitroglycerin and CCB may be more effective than a single agent for preventing RA graft spasm 31 .…”

Section: Discussionmentioning

confidence: 99%

Perioperative Application of Diltiazem in Patients Undergoing On-Pump Coronary Artery Bypass Grafting

Zhang

Friscia

et al. 2022

Preprint

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Diltiazem is frequently applied during the perioperative period of coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG) to prevent arterial graft spasm; however, the short- and long-term outcome effects are unclear. In this retrospective cohort study, from October 2008 to October 2018, adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) were identified. Patients in the perioperative diltiazem (DILT) and non-intervention (non-DILT) cohorts were matched based on propensity scores. Logistic regression was fitted to evaluate the impact on short-term outcomes. Long-term outcome was investigated by survival analyses. Total of 1004 patients were included. There were no statistically significant differences between the cohorts in perioperative outcomes, although at 24 hours postoperatively, patients in DILT were more likely to be on hemodynamic support from inotropic and/or vasoactive agents. The overall long-term survival was similar between the cohorts; however, in the subgroup of patients who received more than one arterial graft, perioperative diltiazem may be associated with higher long-term all-cause mortality. Based on these data, the perioperative and long-term outcome benefits of continuous iv infusion of diltiazem in patients who underwent on-pump CABG.

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Section: Discussionmentioning

confidence: 99%

Perioperative Application of Diltiazem in Patients Undergoing On-Pump Coronary Artery Bypass Grafting

Zhang

Friscia

et al. 2022

Preprint

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“…In addition, data from recent studies investigating various categories of vasodilators show that the antispasmodic effects depend on the type of vessels and their specific mechanisms of graft spasm. 31 , 32 , 33 , 34 , 35 Taken together, the evidence suggests that instead of applying diltiazem to every patient, tailoring the antispasmodic interventions to the type and condition of the arterial grafts and the clinical condition of each individual patient may be more effective. A large-scale, multicentre retrospective outcome study may be warranted to better understand the effects of diltiazem on arterial grafts.…”

Section: Discussionmentioning

confidence: 99%

Perioperative diltiazem therapy was not associated with improved perioperative and long-term outcomes in patients undergoing on-pump coronary artery bypass grafting

Zhang¹,

Hu²,

Friscia³

et al. 2022

BJA Open

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“…Diltiazem is a calcium channel blocker which acts through L-type channel blockage [ 1 , 26 ] . It is another commonly applied vasodilator agent to prevent vasospasm and increase flow of coronary artery bypass conduits during CABG.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Apoptotic Effects of Topically Applied Papaverine, Diltiazem, and Nitroprusside to Internal Thoracic Artery

Ünal¹,

Ulukan²,

Bakuy³

et al. 2020

Braz J Cardiovasc Surg

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Objective To detect and to compare the apoptotic effects of intraoperatively topically applied diltiazem, papaverine, and nitroprusside. Methods Internal thoracic artery segments of ten patients were obtained during coronary bypass grafting surgery. Each internal thoracic artery segment was divided into four pieces and immersed into four different solutions containing separately saline (Group S), diltiazem (Group D), papaverine (Group P), and nitroprusside (Group N). Each segment was examined with both hematoxylin-eosin and the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) method in order to determine and quantify apoptosis. Results Apoptotic cells were counted in 50 microscopic areas of each segment. No significant difference was observed among the four groups according to hematoxylin-eosin staining. However, the TUNEL method revealed a significant increase in mean apoptotic cells in the diltiazem group when compared with the other three groups (Group S=4.25±1.4; Group D=13.31±2.8; Group N=9.48±2.09; Group P =10.75±2.37). The differences between groups were significant ( P =0.0001). No difference was observed between the samples of the diabetic and non-diabetic patients in any of the study groups. Conclusion The benefit of topically applied vasodilator drugs must outweigh the potential adverse effects. In terms of apoptosis, diltiazem was found to have the most deleterious effects on internal thoracic artery graft segments. Of the analyzed medical agents, nitroprusside was found to have the least apoptotic activity, followed by papaverine. Diabetes did not have significant effect on the occurrence of apoptosis in left internal thoracic artery grafts.

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Comparison of direct effects of clinically available vasodilators; nitroglycerin, nifedipine, cilnidipine and diltiazem, on human skeletonized internal mammary harvested with ultrasonic scalpel

Cited by 7 publications

References 20 publications

Perioperative Application of Diltiazem in Patients Undergoing On-Pump Coronary Artery Bypass Grafting

Perioperative Application of Diltiazem in Patients Undergoing On-Pump Coronary Artery Bypass Grafting

Perioperative diltiazem therapy was not associated with improved perioperative and long-term outcomes in patients undergoing on-pump coronary artery bypass grafting

Comparison of the Apoptotic Effects of Topically Applied Papaverine, Diltiazem, and Nitroprusside to Internal Thoracic Artery

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