ISSN: 2630-5720 | E-ISSN: 2687-346X

Hızlı Arama




Journal of Psychiatric Nursing
Comparison of iloprost and papaverine in topical vasodilation of internal mammary artery in coronary artery bypass grafting: A prospective randomized trial []
. 2020; 60(1): 76-84 | DOI: 10.14744/hnhj.2020.49379

Comparison of iloprost and papaverine in topical vasodilation of internal mammary artery in coronary artery bypass grafting: A prospective randomized trial

Emine Şeyma Denli Yalvaç1, Ozan Onur Balkanay2, Deniz Göksedef2, Suat Hilal Aki3, Suat Nail Ömeroğlu2, Gökhan İpek2
1Medeniyet Üniversitesi, Göztepe Eğitim ve Araştırma Hastanesi, Kardiyovasküler Cerrahi Kliniği, İstanbul
2İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Kardiyovasküler Cerrahi Anabilim Dalı, İstanbul
3İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Patoloji Anabilim Dalı, İstanbul

GİRİŞ ve AMAÇ: Introduction: Internal mammary artery (IMA) graft is a commonly used coronary artery bypass conduit due to its high long-term patency rates. Besides, IMA can have a perioperative arteriel spasm problem. Papaverine, an opium alkaloid, is commonly used in vasospasm, especially for IMA. Iloprost, a synthetic prostacyclin analogue, could be an alternative to papaverine. In this study, we compared the effect of topical iloprost and papaverine in terms of prevention of IMA vasospasm.

YÖNTEM ve GEREÇLER: Between May-August 2009, 40 consequtive patients who underwent coronary artery bypass grafting using IMA graft were included in the prospective study. Patients were divided into two groups in order to be treated with topical vasodilators as iloprost and papaverine groups. Free blood flow of IMA were measured before and after the topical vasodilators were applied. These results were evaluated together with concurrently measured mean arterial pressures. Histopathologic examination was performed with the distal part of IMA and scored according to the desquamation rate.
BULGULAR: Preoperative and haemodynamic parameters between the two groups were similar. With both vasodilator agents, the amount of IMA blood flow were increased in similar ratio as well. Analysis of this increase was assessed by dividing the blood flow by the mean arterial blood pressure value. Iloprost group had similar vasodilation response when compared with the response of papaverine group. Besides, there was more desquamation in the papaverine group at a significant level. There was no significant difference between the two groups in terms of postoperative mortality and complications.
TARTIŞMA ve SONUÇ: We concluded that iloprost could be an alternative for papaverine with similar vasodilation response and lower level of endothelial damage.

Anahtar Kelimeler: Internal mammarian artery, graft spasm, iloprost, vascular relaxation, endothelium, coronary artery bypass grafting

Comparison of Iloprost and Papaverine in Topical Vasodilation of Internal Mammary Artery in Coronary Artery Bypass Grafting: A Prospective Randomized Trial

Emine Şeyma Denli Yalvaç1, Ozan Onur Balkanay2, Deniz Göksedef2, Suat Hilal Aki3, Suat Nail Ömeroğlu2, Gökhan İpek2
1Department of Cardiovascular Surgery, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
2Department of Cardiovascular Surgery, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
3Department of Pathology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey

INTRODUCTION: Internal mammary artery (IMA) graft is a commonly used coronary artery bypass conduit due to its high long-term patency rates. IMA may have a perioperative arterial spasm problem. Papaverine, an opium alkaloid, is commonly used in vasospasm, especially for IMA. Iloprost, a synthetic prostacyclin analogue, could be an alternative to papaverine. In this study, we compared the effects of topical iloprost and papaverine concerning the prevention of IMA vasospasm.
METHODS: Between May-August 2009, 40 consecutive patients who underwent coronary artery bypass grafting using IMA graft were included in this prospective study. Patients were divided into two groups to be treated with topical vasodilators as iloprost and papaverine groups. The free blood flow of IMA was measured before and after the topical vasodilators were applied. These results were evaluated together with concurrently measured mean arterial pressures. Histopathologic examination was performed with the distal part of IMA and scored according to the desquamation rate.
RESULTS: Preoperative and haemodynamic parameters between the two groups were similar. With both vasodilator agents, the amount of IMA blood flow was increased in a similar ratio as well. Analysis of this increase was assessed by dividing the blood flow by the mean arterial blood pressure value. Iloprost group had similar vasodilation response when compared with the response of the papaverine group. There was more desquamation in the papaverine group at a significant level. There was no significant difference between the two groups in terms of postoperative mortality and complications.
DISCUSSION AND CONCLUSION: We concluded that iloprost could be an alternative for papaverine with similar vasodilation response and lower level of endothelial damage.

Keywords: Coronary artery bypass grafting, endothelium; graft spasm; internal mammary artery; iloprost; vascular relaxation.

Emine Şeyma Denli Yalvaç, Ozan Onur Balkanay, Deniz Göksedef, Suat Hilal Aki, Suat Nail Ömeroğlu, Gökhan İpek. Comparison of Iloprost and Papaverine in Topical Vasodilation of Internal Mammary Artery in Coronary Artery Bypass Grafting: A Prospective Randomized Trial. . 2020; 60(1): 76-84

Sorumlu Yazar: Emine Şeyma Denli Yalvaç, Türkiye
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