Topical vasodilators for preventing radial artery spasm during harvesting for coronary revascularization: comparison of 4 agents

There is still controversy about which vasodilator solution is best for storing radial artery (RA) conduits prior to coronary artery bypass grafting. The aim of this pilot study was to investigate how 4 different topical vasodilators applied during RA harvesting affect blood flow with the vessel in situ. The subjects were 85 patients who underwent RA harvesting in preparation for coronary artery bypass grafting. Each case was assigned to 1 of 5 groups (17 RAs each) that were treated with different solutions: normal saline (control), nitroglycerin, diltiazem, papaverine, and adenosine. Standard clinical concentrations were used. The RA was partially harvested (pedicle attached proximally) and flow rates and hemodynamic parameters (mean arterial pressure, heart rate, central venous pressure) were recorded at 2 time points: (1) pretreatment and (2) after 5 minutes of immersion in 60 mL of treatment solution. Results were compared within and between groups, and post-treatment-to-pretreatment ratios were calculated for each variable. There were no significant differences among the groups' mean pretreatment flow rates (P = .979) or mean posttreatment flow rates (P = .069). All except the diltiazem group showed a significant rise in mean flow rate from pretreatment to posttreatment. The mean posttreatment-to-pretreatment ratios for RA flow rate were 1.28 +/- 0.39 in the saline group, 1.85 +/- 0.72 in the nitroglycerin group, 1.31 +/- 0.48 in the diltiazem group, 1.37 +/- 0.64 in the papaverine group, and 1.23 +/- 0.42 in the adenosine group. Only the mean flow ratio in the nitroglycerin group was significantly higher than that in the saline group (P = .003). The mean flow ratios in the other vasodilator groups were not statistically different from the flow ratio in the saline group. These preliminary results indicate that topical application of nitroglycerin solution effectively prevents perioperative spasm of the RA in patients undergoing coronary artery bypass surgery. The authors recommend this solution for preparation and storage of RA grafts. Randomized controlled trials with power analysis will give more definitive information.