The effect of nebivolol on internal mammary artery blood flow during coronary artery bypass graft surgery

Sarikaya, Sabit; Onk, Alper; Boztosun, Bilal; Kocabay, Gönenç; Şahin, Müslüm; Fedakar, Ali; Köksal, Cengiz

doi:10.1177/0267659113517921

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…In our study, the IMA flow was higher in the hypertensive patients than in the non-hypertensive patients, with a significant difference in flow. This high flow pattern might be related to some antihypertensive medicines that the patient was taking before surgery, as shown in other studies, as these drugs have vasodilatory effects [ 12 ].…”

Section: Discussionmentioning

confidence: 62%

“…The left internal mammary artery is routinely used for the left anterior descending coronary artery as a part of an elective coronary artery bypass grafting procedure due to its excellent long-term patency and long-term survival in CABG patients [ 1 ]. Several previous studies have shown that a careful harvesting technique for the IMA is associated with the good flow and only occasionally topical vasodilators are used to overcome the spasm, while none of them emphasize on its relationship with different diseases and conditions [ 11 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Association of Internal Mammary Artery Flow with Different Comorbidities and Post-Coronary Artery Bypass Graft Complications

Dar

Bilal

et al. 2017

Cureus

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ObjectiveThe internal mammary artery (IMA) is commonly used arterial graft for coronary artery bypass surgery (CABG). The IMA has a better patency and survival. This study considers different comorbidities and conditions where IMA flow may be low. Therefore, the main objective is to determine the flow of IMA in different diseases, its relation to gender, age, and in different blood groups in order to prevent possible complications.MethodsA prospective study was conducted at the Cardiac Surgery Unit, Civil Hospital Karachi from January 2013 to December 2015. The data of 158 patients who underwent primary, isolated, and CABG surgery was collected. Free flow of IMA was measured immediately after harvesting for 30 seconds within a syringe, and its relationship with different diseases and conditions was examined. Data was collected using a structured questionnaire from the patients' medical record files and it was later analyzed and entered into the Statistical Package for Social Sciences (SPSS) software, V17 (IBM SPSS Statistics, Armonk, NY).ResultsThe mean flow was 11.6 ± 9.6 ml. There was no difference in flow related to gender, diabetes, smoking, renal disease, and chronic obstructive pulmonary disease (COPD). There was significantly higher flow in the age group of 50 to 60 years (p = 0.002), hypertensive patients (p = 0.016), patients with liver disease (p = 0.001), BMI > 30 (p = 0.041), and the blood group AB+ (p = 0.02). The atrial fibrillation and readmissions were higher in patients who had low flow. Low flow IMA, which was used on left anterior descending (LAD) artery stenosis patients, showed a significantly higher need of pharmacological and mechanical support.ConclusionIMA should be used carefully in patients where its flow is low; conditions must be analyzed where flow may be low to avoid complications. Further studies are warranted.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Association of Internal Mammary Artery Flow with Different Comorbidities and Post-Coronary Artery Bypass Graft Complications

Dar

Bilal

et al. 2017

Cureus

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“…13,14 Chan and colleagues 11 found that those patients who were discharged and prescribed beta-blockers after cardiac surgery exhibited a substantially lower rate of death at 1 year. Sarikaya and colleagues 15 suggest that nebivolol might be considered a good choice in hypertensive patients undergoing cardiac surgery, given its prevention of perioperative myocardial hypoperfusion, which increases early morbidity and mortality. Bayar and colleagues 16 suggest that nebivolol may be safer and preferable to diminish graft spasm in patients undergoing CABG surgery because of the NO-mediated vasodilation effect.…”

Section: Discussionmentioning

confidence: 99%

Labetalol, nebivolol, and propranolol relax human radial artery used as coronary bypass graft

Korkmaz

Saraç

Göksel

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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We speculated that the relaxant effect of labetalol, nebivolol, and propranolol was due partly to the Ca(2+)-activated K(+) channels. In addition, the relaxation induced by nebivolol was largely related with nitric oxide release. Nebivolol, and partly propranolol, may provide significant therapeutic benefit, but labetalol can be a good alternative for coronary artery bypass grafting with radial artery use.

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“…The primary limitation of our study was that there were no flow measurements made after applying the papaverin. In a recently published paper, Sarikaya et al [25] reported that when compared with other antihypertensive drugs, pretreatment with nebivolol increases the IMA GFF even after papaverine usage. The second limitation was that the medication was only used for a short time in the study groups, Although there was a statistical difference in our study, longer times of pretreatment will undoubtfully strengthen our results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effect of nebivolol, metoprolol and diltiazem on tissue nitric oxide synthase activity in internal mammary artery

Bakuy¹

2014

Turk Gogus Kalp Dama

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Bu çalışmada metoprolol ve diltiazeme kıyasla, insan internal mammariyan arterinde nitrik oksit sentaz aktivite düzeyine nebivololün etkisi araştırıldı. Ça lış ma pla nı: Çalışmaya koroner arter bypass greftleme planlanan 75 hasta (43 erkek, 32 kadın; ort. yaş 61.6±5.8 yıl; dağılım 41-76 yıl) dahil edildi. Hastalar randomize olarak üç gruba ayrıldı. Ameliyattan beş gün önce grup 1'de 50 mg metoprolol, grup 2'de 5 mg nebivolol ve grup 3'de 90 mg diltiazem tedavisi başlandı. Ameliyat sırasında internal mammariyan arterinden doku örnekleri alındı. Kantitatif sandwich enzim bağlı immünosorbent assay tekniği ile nitrik oksit sentaz aktivitesi ölçüldü ve serbest greft akımı hesaplandı. Bul gu lar: Ortalama doku nitrik oksit sentaz aktivitesi grup 1'de 0.4±0.0 U/mg, grup 2'de 2.4±0.3 U/mg ve grup 3'de 0.4±0.0 U/mg bulundu. Grup 2'de daha yüksek olmakla birlikte, gruplar arasında nitrik oksit sentaz aktivitesi açısından istatistiksel olarak anlamlı farklılık saptandı (p<0.05). Ortalama serbest greft akımı, diğer gruplara kıyasla, grup 2'de anlamlı düzeyde daha yüksekti (p<0.01). So nuç: Çalışmamızın sonuçları, ameliyat öncesi nebivolol tedavisinin insan internal mammariyan arterinde, metoprolol ve diltiazeme kıyasla, doku nitrik oksit sentaz konsantrasyonunu ve serbest greft akımını artırdığını göstermektedir. Anah tar söz cük ler: Koroner arter baypas greftleme; internal mammariyan arter; nebivolol; nitrik oksit; nitrik oksit sentaz. Background: This study aims to evaluate the effects of nebivolol on nitric oxide synthase activity in human internal mammary artery compared to metoprolol and diltiazem. Methods: Seventy-five patients (43 males, 32 females; mean age 61.6±5.8 years; range 41 to 76 years) who were scheduled for coronary artery bypass grafting were enrolled in this study. Patients were assigned randomly to three groups. In group 1, 50 mg metoprolol, in group 2 5 mg nebivolol, and in group 3 90 mg diltiazem therapy was initiated five days before surgery. Samples of internal mammary artery were obtained intraoperatively. Nitric oxide synthase activity was measured by the quantitative sandwich enzyme-linked immunosorbent assay and graft free flow was calculated. Results: The mean tissue nitric oxide synthase activity was found to be 0.4±0.0 U/mg in group 1, 2.4±0.3 U/mg in group 2 and 0.4±0.0 U/mg in group 3. There was a significant difference in the mean tissue nitric oxide synthase activity among the groups (p<0.05) with a higher rate in group 2. The mean graft free flow was significantly higher in group 2 compared to other groups (p<0.01). Conclusion:Our study results suggest that preoperative nebivolol therapy increases tissue nitric oxide synthase concentration and graft free flow in the human internal mammary artery compared to metoprolol and diltiazem.

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The effect of nebivolol on internal mammary artery blood flow during coronary artery bypass graft surgery

Abstract: Nebivolol might represent a good choice in hypertensive patients undergoing cardiac surgery by preventing perioperative myocardial hypoperfusion which increases early morbidity and mortality.

Cited by 4 publications

References 27 publications

Association of Internal Mammary Artery Flow with Different Comorbidities and Post-Coronary Artery Bypass Graft Complications

Association of Internal Mammary Artery Flow with Different Comorbidities and Post-Coronary Artery Bypass Graft Complications

Labetalol, nebivolol, and propranolol relax human radial artery used as coronary bypass graft

Comparison of the effect of nebivolol, metoprolol and diltiazem on tissue nitric oxide synthase activity in internal mammary artery

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