Skeletonized Radial Artery Graft Prepared with Phosphodiesterase-III Inhibitors Indicates Favorable Results Compared with Pedicled Radial Artery Graft in Angiographic Studies

Yamaguchi, Shohjiro; Watanabe, Go; Higasidani, Kohichi; Tomita, Shigeyuki; Iino, Kenji; Ujiie, Toshimi; Yamamoto, Shinichiro

doi:10.1177/155698450600100506

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…The PDEIII inhibitors such as amrinone or milrinone are known to inhibit cGMP-inhibitable low Km cAMP PDE [32]. The effect of the PDEIII inhibitor milrinone on the IMA [11,33] or RA [34] and PDEIIIA inhibitor olprinone on the GEA and RA [35] have been shown effective, and it is noted that the effect of milrinone on the IMA is superior to that on the RA. In systemic use, after cardiopulmonary bypass, perioperative continuous infusion of milrinone, compared with nifedipine, results in a significantly lower incidence of myocardial ischemia and myocardial cell damage [36].…”

Section: Phosphodiesterase Inhibitorsmentioning

confidence: 99%

“…Skeletonization of grafts was initially used in IMA. It has been suggested that skeletonized arterial graft may denervate the vessel, reduce the risk of spasm, and improve graft patency in GEA [67][68][69] and RA [35], and this is often done with the ultrasonic scalpel [69]. Conversely, studies have demonstrated that skeletonization with an ultrasonic scalpel did not result in additional length and was more frequently associated with severe endothelial damage [70], and that en bloc free GEA graft, which has the gastroepiploic vein anastomosed to the right atrial appendage [71], can prevent graft spasm, leading to improved patency rate.…”

Section: Skeletonization Denervation or En Bloc Harvesting?mentioning

confidence: 99%

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Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

Taggart

2016

The Annals of Thoracic Surgery

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Arterial grafts have long-term patency superior to vein grafts but have a tendency to develop spasm that can lead to potentially life-threatening complications. A perfect antispastic protocol should include advanced surgical technique and adequate pharmacologic methods. All pharmacologic vasodilator drugs relax the vessel through specific mechanisms, and therefore, there is no perfect, single best vasodilator to prevent or treat spasm of the arterial graft against all mechanisms of contraction. One of the choices is to use a combination of pharmacologic vasodilators targeting different mechanisms of spasm to obtain the reliable and best effect.

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Section: Phosphodiesterase Inhibitorsmentioning

confidence: 99%

Section: Skeletonization Denervation or En Bloc Harvesting?mentioning

confidence: 99%

Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

Taggart

2016

The Annals of Thoracic Surgery

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“…Phospodiesterase III inhibitors including papaverine have been shown to have vasodilatory effect on radial artery. 12 The nitrate derivatives including glycerin trinitrate, isosorbide dinitrate, sodium nitroprusside, and nicorandil possess vasodilatory effect. Nitroglycerin has been reported to be effective in preventing spasm of radial artery graft.…”

Section: Commentmentioning

confidence: 99%

Fasudil is an Effective Graft Vasodilator for Gastroepiploic Artery in Coronary Artery Bypass Grafting

Watanabe

Yamaguchi

Tomita

et al. 2015

Innovations�(Phila)

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Objective The gastroepiploic artery (GEA) has been used as an alternative arterial in situ graft for coronary artery bypass grafting (CABG). However, because of the large individual differences and the spastic nature of the GEA, caution has to be exercised during harvesting. We evaluated the usefulness of fasudil, a Rho kinase inhibitor, as a vasodilator for right GEA (RGEA) graft after harvesting, compared with the conventional agents papaverine and verapamil-nitroglycerin. Methods Between June 2009 and January 2013, 30 patients with ischemic heart disease who underwent isolated CABG using RGEA graft were randomly assigned to fasudil (n = 10), papaverine (n = 10), or verapamil-nitroglycerin (n = 10) group. Fasudil (2.67 mmol/L), papaverine (1.0 mmol/L) mixed with heparinized blood, or verapamil-nitroglycerin (30 μmol/L each) was injected intraluminally into the RGEA graft after harvesting. Right GEA graft free flow (GFF), hemodynamic changes, and histopathology of RGEA were evaluated. Results Intraluminal injection of fasudil increased GFF significantly (P < 0.001) and markedly from 41.5 ± 31.5 mL/min at baseline to 149.3 ± 46.7 mL/min after injection. Papaverine increased GFF (P < 0.001) from 40.0 ± 35.8 to 64.9 ± 33.7 mL/min, and verapamil-nitroglycerin also increased GFF (P < 0.001) from 38.8 ± 32.1 to 79.0 ± 35.2 mL/min. The GFF was significantly higher (P = 0.001) in the fasudil group than in the other two groups. Histopathologically, fasudil treatment markedly increased the diameter of RGEA graft, while maintaining integrity of the multiple elastic lamellae. Blood pressure did not change significantly after drug injection in all groups. Conclusions Fasudil is more potent than papaverine or verapamilnitroglycerin in increasing GFF of RGEA graft for CABG.

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Fasudil is an Effective Graft Vasodilator for Gastroepiploic Artery in Coronary Artery Bypass Grafting

et al. 2015

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Skeletonized Radial Artery Graft Prepared with Phosphodiesterase-III Inhibitors Indicates Favorable Results Compared with Pedicled Radial Artery Graft in Angiographic Studies

Cited by 3 publications

References 8 publications

Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

Antispastic Management in Arterial Grafts in Coronary Artery Bypass Grafting Surgery

Fasudil is an Effective Graft Vasodilator for Gastroepiploic Artery in Coronary Artery Bypass Grafting

Fasudil is an Effective Graft Vasodilator for Gastroepiploic Artery in Coronary Artery Bypass Grafting

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