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Background and Aim Of the Study: In vitro studies have shown a reduction in radial artery spasm with the use of calcium antagonists. The purpose of this study was to evaluate the efficacy of topical treatment of the radial artery conduit using either verapamil or nicardipine before the anastomoses.Methods: This prospective randomized study included 131 patients, who underwent coronary artery bypass grafting surgery with the use of the radial artery as a conduit. In 65 patients, the harvested radial artery was topically treated with verapamil and in 66 patients with nicardipine. After harvesting the radial artery, the direct flow through the conduit was measured in vitro before 5-minute incubation in nicardipine or verapamil and measured again after incubation. The flow before and after incubation was compared. Postincubation flow was also compared in the two groups. After performing the anastomosis, the flow through the radial artery was measured in vivo.Results: The mean flow after NaCl incubation was 19.93 ± 12.66 mL/min and after incubation in the Ca+ channel blocker 47.16 ± 14.58 mL/min (P < .001). No significant difference in postincubation free flow was found between verapamil (46.29 ± 15.43 mL/min) and nicardipine (48.01 ± 13.77 mL/min; P = .503).Conclusion: Topical treatment with Ca+ channel blockers reduces radial artery spasm and significantly increases the free flow through the radial artery conduit. Nicardipine is a safe and effective alternative of verapamil in preventing spasm of radial artery conduit. [ABSTRACT FROM AUTHOR]

Background:We researched our data to determine whether use of radial artery (RA) led to similar hospital morbidity as use of pedicled internal thoracic artery (ITA) with vein grafts. We also investigated if use of RA, different RA operative techniques, or number of inflow grafts were predictors for hospital outcome.Method:Retrospectively the hospital outcome of the first 512 patients with RAs (RA group) was compared with 108 matched patients with left ITA (LITA) and vein grafts (LITA control group). Two subgroups of RA operative techniques were further analyzed: 327 patients with RA directly from aorta (aorta-RA group), and 185 patients with RA from ITA, as a composite graft, (ITA-RA group).Results:Hospital outcome of the RA group was similar to that of the LITA control group. When all ischemic events (IE) were grouped together, univariate analysis showed that aorta-RA group resulted in less IE than the ITA-RA group (2.1% versus 5.9%, respectively, p= 0.025). Number of inflow grafts did not influence IE. Multivariate analysis, however, did not show that technique of proximal RA anastomosis or number of inflow grafts were predictors for IE.Conclusions:Hospital outcome after the use of the RA is similar to that of LITA with vein grafts. Univariate analysis shows less IE after direct aorta-RA anastomoses, but multivariate analysis did not show that technique of proximal RA anastomosis and number of inflow grafts are important predictors for hospital outcome.(J Card Surg 2004;19:520-527) [ABSTRACT FROM AUTHOR]

We describe a case of coronary-subclavian steal in a 60-year-old man who presented with progressive ischemia 16 years after coronary artery bypass with in-situ bilateral internal thoracic artery grafts. Angiography revealed completely patent arterial grafts, but subtotal stenosis of the left subclavian artery. On reoperation, a vein graft was used to connect the aorta to the left internal thoracic artery which was proximally disrupted. No coronary ischemia was found postoperatively. [ABSTRACT FROM PUBLISHER]