Diltiazem provides higher internal mammary artery flow than nitroglycerin during coronary artery bypass grafting surgery

Abstract

Diltiazem infusion which started prior to harvesting provided higher IMA blood flow compared to nitroglycerin infusion. Considering the percentage of increases in flows after resection of distal segment, the most prone part to vasospasm, we assume that a certain amount of spasm occurred in IMA in spite of infusion of study drugs, such that less with diltiazem and more with nitroglycerin. Diltiazem plays more important role than nitroglycerin in the prevention of vasospasm.

Vasorelaxing effect of levosimendan against 5-hydroxytryptamine-induced contractions in isolated human conduit bypass grafts

“…Vasodilator therapy includes drugs with different mechanisms of action, including calcium channel blockers (Acar et al 1992;Borger et al 1998), papaverine (Acar et al 1992), milrinone (Tatoulis et al 1998), nitroglycerin (Zabeeda et al 2001), nicorandil (Sadaba et al 2000) and adrenergic receptor blockers (Taggart et al 2000;Mussa et al 2003). Nitroglycerin and diltiazem are the preferred drugs for relieving or preventing graft spasm (Shapira et al 1999;Tabel et al 2004). However, most of these drugs are devoid of inotropic action and may even deteriorate cardiac contractility, for example the calcium antagonists, or decrease or increase heart rates, effects that may be harmful in the peri-CABG setting.…”

Effects of intraoperative diltiazem infusion on flow changes in arterial and venous grafts in coronary artery bypass graft surgery

“…In the study of Tabel et al [ 15 ] , half of the patients undergoing elective CABG were given diltiazem and the other half was given NTG together with anesthesia induction. Two measurements had been taken.…”

Prevention of arterial graft spasm in rats using a vasodilator-eluting biodegradable nano-scaled fibre

“…There is a report asserting milrinone is more effective than other PDE III inhibitors (amrinone and olprinone) for the relaxation of the internal thoracic arterial graft, which is most frequently used as an arterial graft in CABG [8]. On the other hand, systemic infusion of diltiazem, which was started prior to harvesting, provided increased internal thoracic arterial blood flow by prevention spasm [12]. Diltiazem relaxes the contraction of the ITA induced by KCL, or human urotensin II and diltiazem are more effective than glyceryl trinitrate for preventing the contraction in vitro [22].…”

“…We chose to use milrinone (Wako Jyunyaku) and diltiazem (Wako Jyunyaku) as vasodilators, because the local administration of milrinone is clinically performed during bypass surgery for the prevention and treatment of arterial spasms, in the ITA, gastroepiproic artery (GEA) and radial artery (RA) [7]. Systemic administration of diltiazem is also commonly used in bypass surgery to prevent spasm [12].…”