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Eur J Cardiothorac Surg 2003;24:547-551
© 2003 Elsevier Science NL

Dopexamine increases internal mammary artery blood flow following coronary artery bypass grafting

Departments of Cardiothoracic Surgery, Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton, Cork, Ireland

Received 3 January 2003; received in revised form 12 March 2003; accepted 16 June 2003.

^* Corresponding author. Department of Cardiac Surgery, Freeman Hospital, High Heaton, Newcastle-on-Tyne NE7 7DN, UK. Tel.: +44-191-284-3313; fax: +44-191-222-6587
e-mail: barradrum{at}hotmail.com

Objective: Vasoactive agents and inotropes influence conduit-coronary blood flow following coronary artery bypass grafting (CABG). It was hypothesized that dopexamine hydrochloride, a dopamine A-1 (DA-1) and ß₂ agonist would increase conduit-coronary blood flow. A prospective randomized double blind clinical trial was carried out to test this hypothesis. DA-1 receptors have previously been localized to human left ventricle. Methods: Twenty-six American Society of Anaesthesiology class 2–3 elective coronary artery bypass graft patients who did not require inotropic support on separation from cardiopulmonary bypass (CPB) were studied. According to a randomized allocation patients received either dopexamine (1 µg/kg per min) or placebo (saline) by intravenous infusion for 15 min. Immediately prior to and at 5,10 and 15 min of infusion, blood flow through the internal mammary and vein grafts (Transit time flow probes, Transonic Ltd.), heart rate, cardiac index, mean arterial pressure and pulmonary haemodynamics were noted. The data were analysed using multivariate analysis of variance. Results: Low-dose dopexamine (1 µg/kg per min) caused a significant increase in mammary graft blood flow compared to placebo at 15 min of infusion (P=0.028, dopexamine group left internal mammary artery (LIMA) flow of 43.3±14.2 ml/min, placebo group LIMA flow at 26.1±16.3 ml/min). Dopexamine recipients demonstrated a non-significant trend to increased saphenous vein graft flow (P=0.059). Increased heart rate was the only haemodynamic change induced by dopexamine (P=0.004, dopexamine group at 85.2±9.6 beats/min and placebo group at 71.1±7.6 beats/min after 15 min of infusion). Conclusion: This study demonstrates that administration of dopexamine (1 µg/kg per min) was associated with a significant increase in internal mammary artery graft blood flow with mild increase in heart rate being the only haemodynamic change. Low-dose dopexamine may improve graft flow in the early post CABG period with minimal haemodynamic changes.

Key Words: Graft flow • Dopexamine • Left internal mammary artery • Saphenous vein graft • Dopamine A-1 receptor • Dopamine ß₂ receptor

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