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.