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Eur J Cardiothorac Surg 1998;13:332-333
© 1998 Elsevier Science NL

Letter to the Editor

Temporary distal occlusion for non-pharmacological preconditioning of harvested internal mammary artery grafts

Thorsten Wittwer, Thorsten Wahlers, Ulrich Franke, Axel Haverich

Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625 Hannover, Germany

Received 15 October 1997; received in revised form 2 January 1998; accepted 14 January 1998.

Corresponding author. Tel.: +49 511 5326580; fax: +49 511 5325404; e-mail: Th.Wittwer-MD@t-online.de

Abstract

Perioperative spasm of the internal mammary artery (IMA) may result in early restriction of bypass flow. Therefore, pharmacological pretreatment is usually suggested. We present a technique of temporary distal occlusion of the transsected IMA using a metal clip. After 1 hour of storage in normal saline (SAL) there were significantly better flow rates compared with proximal application of a bull-dog clamp. No further increase in flow was noticed after submersion of the IMA pedicle in verapamil (VER). This technique easily provides sufficient IMA flow at the time of anastomosis, probably due to continuous endoluminal dilatation of the IMA by blood pressure, and thus avoids pharmacological pretreatment with vasodilators.

Key Words: Coronary surgery • Internal mammary artery flow • Arterial spasm • Endoluminal dilatation






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Copyright © 1998 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.