The potential use of type-5 phosphodiesterase inhibitors in coronary artery bypass graft surgery.
Exaggerated vasospasm, platelet activation, and early graft occlusion are significant barriers to successful coronary artery bypass grafting (CABG). Interestingly, vascular smooth muscle and platelets are predominant sources of type-5 phosphodiesterase (PDE5) in the body, and this enzyme is specifically inhibited by PDE5 inhibitors (eg, sildenafil citrate). Together with endogenous nitric oxide, sildenafil can induce pulmonary and coronary vasodilation, precondition the myocardium, reduce platelet activation, and potentially reduce early graft occlusion. Currently, there are no published clinical trials investigating sildenafil in coronary surgery. Recent studies on the potential use of sildenafil strongly support its beneficial effects in a wide range of patients with cardiovascular diseases. Therefore, we sought to review the literature, explore the current hypothesis that the use of sildenafil in coronary surgery patients can be beneficial, and attempt to define its potential place in the setting of CABG.
Fung
Erik
E
Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
Fiscus
Ronald R
RR
Yim
Anthony P C
AP
Angelini
Gianni D
GD
Arifi
Ahmed A
AA
D015106:3',5'-Cyclic-GMP Phosphodiesterases / Q000378:metabolism*; D001026:Coronary Artery Bypass; D003329:Coronary Vasospasm / Q000517:prevention & control; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; D006801:Humans; D006976:Hypertension, Pulmonary / Q000517:prevention & control; D019157:Ischemic Preconditioning, Myocardial; D009131:Muscle, Smooth, Vascular / Q000201:enzymology; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D015539:Platelet Activation / Q000187:drug effects; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones
D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate; D015106:3',5'-Cyclic-GMP Phosphodiesterases; D054706:Cyclic Nucleotide Phosphodiesterases, Type 5; C517381:PDE5A protein, human