Effects of Pretreatment with Different Topical Vasodilators on Blood Flow in the Internal Mammary Artery: A Prospective Randomized Study

Battaloğlu, Bektaş; Nisanoğlu, Vedat; Erdil, Nevzat; Özgür, Bülent; Eroğlu, Tamer; Aydin, Nihat; Kaynak, Murat; Seçici, Serkan

doi:10.1532/hsf98.20061166

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…However, there has been no de nitive anatomical evidence supporting that perioperative continuous iv application of diltiazem had a direct vasodilatory effect on coronary grafts after the sternum was closed. Diltiazem became the preferred antispasmodic agent because, compared to nitroglycerine, it had more favorable perioperative outcome pro les, including lower incidences of new onset A-b and cardiac ischemia 7,9,21,22 . Noticeably, data from these RCTs also suggest that patients on diltiazem may need prolonged hemodynamic support from inotropic and/or vasoactive support, indicating that the usage of diltiazem may have potential negative perioperative and long-term outcome impacts 22 .…”

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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“…The literature contains a large number of studies describing the use of papaverine for the indication of intraluminal use for prevention of vasospasm when harvesting and anastomosing arterial and venous grafts. These include a randomized, double-blind, parallel-group comparative study with the medicinal product papaverine in CABG operations [Battaloglu 2007]. One study recommends using papaverine solutions at 37°C to prevent intraoperative spasm [Bilgen 1996].…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetics of Intraluminally Administered Serum Papaverine for Spasm Prophylaxis of the Internal Mammary Artery

Kiessling¹,

Romasku²,

Beiras-Fernández³

et al. 2013

HSF

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“…A previous meta-analysis indicated that perioperative application of different calcium channel blockers (CCBs) had significant outcome benefits for patients undergoing all types of cardiac surgeries requiring cardiopulmonary bypass (CPB)[ 5 ]. Topical application of CCBs on isolated IMAs and RAs consistently showed evidence of vasodilatation and increased blood flow[ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…iloprost[ 13 ]. These investigational drugs were applied in various ways: topically or intra-graft injection[ 6 , 14 ], systemically through bolus and/or intravenous (IV) infusion, or mixed in cardioplegia during CPB[ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative diltiazem or nitroglycerin in on-pump coronary artery bypass: A systematic review and network meta-analysis

Yang

Zhang

et al. 2018

PLoS ONE

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BackgroundArterial graft spasm is a severe complication after coronary artery bypass graft (CABG). Among numerous potential antispasmodic agents, systemic application of diltiazem and nitroglycerin had been investigated most frequently over the past three decades. However, it remains inconclusive if either or both agents could improve patient outcomes by preventing graft spasm when applied perioperatively, and, if so, which one would be a better choice. The current systematic review and network meta-analysis aims to summarize the data from all available randomized clinical trials of perioperative continuous intravenous infusion of diltiazem and/or nitroglycerin in patients undergoing on-pump CABG in order to define and compare their roles in graft spasm prevention and their impacts on perioperative outcomes.MethodsWe searched Ovid Medline, PubMed, CINAHL, Google Scholar and Cochrane Center for randomized controlled trials that reported outcome effects of perioperative continuous intravenous infusion of diltiazem and/or nitroglycerin in patients undergoing elective on-pump CABG. Conventional meta-analyses were conducted to evaluate the pairwise comparisons (diltiazem vs. placebo; nitroglycerin vs. placebo; diltiazem vs. nitroglycerin) on perioperative outcomes. Network meta-analyses were implemented to compare the three regimens through direct and indirect comparison.ResultsTwenty-seven studies involving 1,660 patients were included. Pairwise and network meta-analyses found no significant difference in mortality among the groups. There are four studies that reported blood flow measurements of internal mammary artery grafts intraoperatively after dissecting or immediately after distal anastomosis while patients were on continuous intravenous infusion of diltiazem and nitroglycerin. Although insufficient for data synthesis, the measured results from all four studies suggest that both diltiazem and nitroglycerin significantly increased blood flow of arterial grafts compared to placebo. For other perioperative outcomes, compared to diltiazem, patients that received nitroglycerin had higher odds of postoperative atrial fibrillation (OR = 2.67, 95% CI: 1.15 to 6.24) and higher peak serum cardiac enzymes. Patients that received placebo had higher odds of atrial fibrillation (OR = 3.00, 95% CI: 1.18 to 7.63) and lower odds of requiring inotrope support (OR = 0.19, 95% CI: 0.04 to 0.73) compared to diltiazem. Data from the network meta-analysis indicated that diltiazem had significantly lower odds of postoperative atrial fibrillation compared to nitroglycerin (OR = 0.39, 95% CI: 0.18 to 0.85). In fact, the rank from highest to lowest rates of postoperative atrial fibrillation was placebo>nitroglycerin>diltiazem. The rank from highest to lowest odds of requiring inotropic support is nitroglycerin> diltiazem>placebo. However, placebo had significantly higher odds of postoperative myocardial infarction than diltiazem (OR = 4.51, 95% CI: 1.34 to 15.25). The rank from highest to lowest odds of postoperative myocardial infarctio...

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Effects of Pretreatment with Different Topical Vasodilators on Blood Flow in the Internal Mammary Artery: A Prospective Randomized Study

Cited by 7 publications

References 23 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

Pharmacokinetics of Intraluminally Administered Serum Papaverine for Spasm Prophylaxis of the Internal Mammary Artery

Perioperative diltiazem or nitroglycerin in on-pump coronary artery bypass: A systematic review and network meta-analysis

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