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Nicardipine protocol for CABG using the radial artery clinical and angiographic data
M A Radermecker1, T Grenade, S K Cao-Thian
1Department of Cardiovascular Surgery, C.H.U., Liège, Belgium.
Insights
This study shows that a protocol using papaverine and nicardipine effectively prevents radial artery spasm in coronary artery bypass surgery. This approach ensures high graft patency and good patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Grafting
- Pharmacology
Background:
- Arterial grafts are crucial for coronary artery bypass grafting (CABG).
- Preventing graft spasm is essential for optimal graft function.
- Diltiazem is commonly used, but alternative protocols are explored.
Purpose of the Study:
- To evaluate a spasm prevention protocol for radial artery grafts in CABG.
- The protocol combines hydrostatic dilation with papaverine and nicardipine infusion.
- Assess the efficacy and safety of this combined approach.
Main Methods:
- Fifty patients undergoing myocardial revascularization with radial artery grafts were included.
- Radial arteries were prepared using hydrostatic dilation with 1% papaverine.
- Nicardipine infusion (0.25 µg/kg/min) was administered perioperatively and postoperatively.
- Nicardipine dosage was titrated based on systemic arterial pressure.
Main Results:
- Operative mortality was 4% (sepsis).
- No perioperative myocardial infarction or hypoperfusion syndrome observed.
- Mean peak CKMB level was 36 µg/L at 18 hours.
- ECG showed no ischemic anomalies.
- Angiography revealed a 98% patency rate for all grafts (51/52).
- Radial graft patency was 95% (19/20).
- One graft had proximal anastomosis stenosis; another had moderate spasm.
Conclusions:
- The radial artery is a suitable conduit for routine CABG.
- The papaverine and nicardipine protocol effectively controls radial graft vasoreactivity.
- This regimen is well-tolerated with beta-blockers in perioperative management.
Abstract:
The routine use of arterial grafts in coronary surgery is facilitated by peroperative adjunction of antispasmodic drug to reduce the event of spasm. Diltiazem has been favoured in most clinical studies devoted to the radial artery graft. The aim of this study was to assess the efficacy of a spasm preventing protocol associating hydrostatic dilation of the graft with a diluted solution of papaverine and nicardipine infusion, starting preoperatively and continued postoperatively in i.v. and per os forms. Between September 1996 and March 1997, a consecutive series of 50 patients underwent myocardial revascularization using the radial artery. The radial artery was prepared by hydrostatic dilation with papaverine (1%) and nicardipine was administrated at 0.25 microgram/kg/min and titrated according to the arterial systemic pressure. Operative mortality was 4% (sepsis). There was no evidence of perioperative MI nor hypoperfusion syndrome. Mean CKMB level at 18 hours was 36 micrograms/l. No ischaemic anomalies of the ECG were detected. Angiography performed in the last 20 patients showed a 98% (51/52) permeability rate for all graft; 19/20 radial grafts (95%) were patent. One radial graft presented a 50% stenosis at the proximal anastomosis, and another a moderate spasm (40%) in the middle part of the conduit. This study confirms that the radial artery conduit can be used with satisfactory results for routine coronary artery bypass. The use of nicardipine allows the control the vasoreactivity of the radial graft without totally obviating at least angiographic spasm. This drug is easy to titrate, and well tolerated in association to beta-blockers in the routine perioperative management of the coronary patients.