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Eur J Cardiothorac Surg 2006;30:749-752
© 2006 Elsevier Science NL

Role of physiological state ‘normothermia’ in internal thoracic artery spasm after harvesting

Arif Tarhan^a,_*, Tamer Kehlibar^a, Fikri Yapc^a, Mehmet Ylmaz^a, Yucesin Arslan^a, Nihan Yapc^b, Azmi Özler^a

^a Department of Cardiovascular Surgery, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
^b Department of Anesthesiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey

Received 5 June 2006; received in revised form 31 August 2006; accepted 1 September 2006.

^_* Corresponding author. Address: Hzrbey Caddesi Nesrin Sokak No:1 D:11 Göztepe, Istanbul 81060, Turkey. Tel.: +90 216 3499120 (Business)/90 216 5650699 (Home); fax: +90 216 5652130. (Email: atarhan{at}gmail.com).

Objective: Vasospasm is often faced after the operative preparation of internal thoracic artery. Different vasodilating pharmacological agents are being used to eliminate this problem. During the preparation of internal thoracic artery, normal, local, and systemic temperatures are lost. We aimed to find out the effect of this decrease in temperature on the free flow of internal thoracic artery. Methods: We investigated the effects of normal saline solution at 20 °C (group I), papaverine at 20 °C (group II) and normal saline solution at 37 °C (group III). Each group contained 20 patients undergoing coronary bypass. Free flow of the left internal thoracic artery was measured after mobilization. After approximately 18 min the graft had been sprayed with one of the agents, and the second free flow was measured (t-interval was 18.2 ± 2.1 for group I, 18.3 ± 1.8 for group II, and 17.5 ± 1.9 for group III). Results: Normal saline solution at 20 °C did not cause a significant change. Topical papaverine at 20 °C increased the flow from 42.1 ± 10.7 ml/min to 77.5 ± 17.9 ml/min (p < 0.0001). A significant increase also occurred with normal saline solution at 37 °C from 41 ± 11.9 ml/min to 75.3 ± 18.9 ml/min (p < 0.0001). Conclusions: After harvesting the graft, regaining physiological normothermic state is enough for vasodilatation. Even using one of the most potent vasodilating agent papaverine at 20 °C is not superior to normothermia.

Key Words: Coronary artery bypass grafts • Internal thoracic artery • Hypothermia • Normothermia • Vasospasm

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