Use of nitroglycerin and verapamil solution by organ bath technique in preparation of left internal thoracic artery for coronary artery bypass surgery

Abstract

BackgroundThe aim of this prospective study was to compare the effect of application of nitroglycerin and verapamil solution (GV) by organ bath technique with other methods of applications and solutions on the free blood flow of LITA. The technique was not described for in situ graft before.MethodThe patients were randomly assigned to four groups: group I (n_32, GV solution by organ bath technique), group II (n_30, papaverine solution by organ bath technique), group III (n_29, topical GV solution) or group IV (n_29, topical papaverine solution). In each patient, pedicled LITA was harvested; thereafter applied with the randomized different methods and solutions. The free flow from the distal end of the divided LITA was measured for 15 s under controlled hemodynamic conditions after harvesting (Flow 1). The flow of LITA was measured again just prior to anastomosing the conduit (Flow 2).ResultThe mean blood flow in LITA was 56.2 ± 5.0 ml/min before application of solutions. After application, the mean blood flow in group I:102.3 ± 7.0 ml/min, in group II: 92.7 ± 3.4 ml/min, and in group III: 88.6 ± 2.2 ml/min and in group IV: 81.4 ± 2.1. Proportional increases in blood flow observed in group I (82.6%) > group II (65.1%) > group III (57.6) > group IV (44.8%) (p < 0.05).ConclusionsGV solution by organ bath technique is effective and superior in comparison to use of papaverine using organ bath technique or topical spray of GV or papaverine solution.

Lasting Effects of Surgically Used Topical Vasodilators on DIEP Artery Vascular Function

“…Several studies have demonstrated that verapamil-containing solutions do not cause lasting impairments in vasodilatory function. 10 22 23…”

“…Several studies have demonstrated that verapamilcontaining solutions do not cause lasting impairments in vasodilatory function. 10,22,23 It would be ideal to study the effects of papaverine, lidocaine, and verapamil using arterial samples from additional groups of participants (e.g., healthy, young, and old), but it is difficult to obtain samples from such groups. Therefore, the patients in the current study had a history of breast cancer and therapy (chemotherapy, endocrine therapy, or radiation therapy), which is representative of the majority of patients undergoing the DIEP flap procedure.…”

“…There is evidence that a topical vasodilator mixture containing verapamil does not have lasting impairments on vasodilatory function and improves surgical outcomes. 10 22 23 Thus, data exist that acute administration of papaverine and lidocaine, but not verapamil, disrupts subsequent arterial function, but no studies have compared responses among these topical vasodilators in the same study with surgically used doses.…”

Ultrasound-Guided Transverse Thoracic Muscle Plane Injection vs. Topical Spraying of Papaverine for LIMA Harvesting: A Pilot Study

“…Greftin erken ve geç dönem açıklığını artırmak amacıyla sistemik nitrogliserin-diltiazem, topikal papaverin, topikal milrinon, verapamil-nitrogliserin kombinasyonu gibi farmakolojik yöntemler ve organ banyosu gibi farklı cerrahi tekniklerin yanı sıra anestezistler tarafından gerçekleştirilen stellat ganglion bloğu gibi yaklaşımlar tanımlanmıştır [9] . Chandran R. ve ark.…”

“…Fakat geniş serili çalışmalar ile bu risklerin ortaya çıkma olasılığı ortaya konabilir. Her ne kadar günümüzde papaverin uygulamasında etkin ve güvenli oluşu nedeniyle topikal uygulama genel kabul gören yöntem olsa da organ banyosu gibi farklı modifikasyonlar ile en etkin yöntem arayışı devam etmektedir [9] .…”