Eur J Cardiothorac Surg 2006;29:862
© 2006 Elsevier Science NL
Reply to Mishra
Massimo Chello
*
,
Dario Candura,
Stefano Mastrobuoni
Interdisciplinary Center for Biomedical Research (CIR), Department of Cardiovascular Research, University Campus BioMedico of Rome, Italy
Received 23 January 2006;
accepted 24 January 2006.
* Corresponding author. Address: Unit of Cardiac Surgery, Department of Cardiovascular Sciences, University Campus BioMedico of Rome, Via E. Longoni 83, Rome 00155, Italy. Tel.: +39 06 22541572; fax: +39 06 22541456. (Email: m.chello{at}unicampus.it).
Key Words: Statin • Endothelium • Coronary bypass
We really appreciated Dr Mishra's interest in our study as well as his considerations. As pointed out in the paper (limitation of the study), our population consisted of patients at low-risk for diffuse vascular disease. Although this could not be representative of the real population undergoing coronary surgery, nevertheless it allows a more correct interpretation of endothelial functional data, avoiding important confounding factors (peripheral atherosclerosis or pre-existing endothelial damage due to diabetes or other comorbidities). Regarding Dr Mishra's question on radial artery, as a policy we do not use the radial artery in all patients; in particular, the radial artery has not been used in any patient of this study. As stated in the paper, five patients (three in the statin group and two in the control group) continued diltiazem infusion until 12 h before the first postoperative echo scan, for blood pressure control. Nevertheless, because Diltiazem half-life is reported to be 3.0–4.5 h, likely no significant effect on endothelial function has to be expected at the time of examination. With the above mentioned exception, in the remaining patients all the vasoactive medications have been suspended 24 h before examination. Finally, postoperative statin administration was started only on patient discharge.
